MEDICARE: ONYINYECHUKWU CRYSTAL OKAFOR

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	251E00000X	Home Health Agency
2	376K00000X	Nurse's Aide	304285	AZ

General Provider Information

NPI Number	:	1881434066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONYINYECHUKWU CRYSTAL OKAFOR

Provider Business Mailing Address
First Line	:	13794 W WADDELL RD # 203-152
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	602-777-2194
Fax Number	:

Provider Business Practice Location Address
First Line	:	13794 W WADDELL RD # 203-152
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85379-8499
Country	:	US
Telephone Number	:	602-777-2194
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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