MEDICARE: LILIAN J OKERE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61213224	WA

General Provider Information

NPI Number	:	1811540339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIAN J OKERE

Provider Business Mailing Address
First Line	:	2708 CUMBERLAND TRL
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75181-2160
Country	:	US
Telephone Number	:	469-726-8675
Fax Number	:

Provider Business Practice Location Address
First Line	:	2708 CUMBERLAND TRL
Second Line	:
City	:	BALCH SPRINGS
State	:	TX
Zip	:	75181-2160
Country	:	US
Telephone Number	:	469-726-8675
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	12/21/2021

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