MEDICARE: CONSTANCE IFEOMA OKORO LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	119190	OH

General Provider Information

NPI Number	:	1124226782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE IFEOMA OKORO LPN

Provider Business Mailing Address
First Line	:	5676 BROADVIEW RD
Second Line	:	APT 107
City	:	PARMA
State	:	OH
Zip	:	44134-3548
Country	:	US
Telephone Number	:	216-673-8729
Fax Number	:

Provider Business Practice Location Address
First Line	:	5676 BROADVIEW RD
Second Line	:	APT 107
City	:	CLEVELAND
State	:	OH
Zip	:	44134-3548
Country	:	US
Telephone Number	:	216-673-8729
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	05/29/2012

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