MEDICARE: MRS. NGOZI CAROLINE NWOKOLO APRN

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	207Q00000X	Family Medicine Physician	F05180200	OK

General Provider Information

NPI Number	:	1194204180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NGOZI CAROLINE NWOKOLO APRN

Provider Business Mailing Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-1090
Fax Number	:	405-235-2832

Provider Business Practice Location Address
First Line	:	1515 N CLASSEN BLVD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-6611
Country	:	US
Telephone Number	:	405-232-1090
Fax Number	:	405-235-2832

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

Provider Enumeration Date	:	08/09/2018
Last Update Date	:	08/09/2018

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