MEDICARE: JULIANA NWAKAEGO OKORO RN

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	163W00000X	Registered Nurse	136669-1	MN
2	163WH0200X	Home Health Registered Nurse	136669-1	MN

General Provider Information

NPI Number	:	1356951644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA NWAKAEGO OKORO RN

Provider Business Mailing Address
First Line	:	1401 SILVER LAKE RD NW STE 7
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	165-127-8992
Fax Number	:	612-212-4891

Provider Business Practice Location Address
First Line	:	1401 SILVER LAKE RD NW STE 7
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-9307
Country	:	US
Telephone Number	:	165-127-8992
Fax Number	:	612-212-4891

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	08/03/2020

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