Provider Demographics
NPI:1093197832
Name:OKEAKPU, EMEKA GERALD (CNA)
Entity type:Individual
Prefix:
First Name:EMEKA
Middle Name:GERALD
Last Name:OKEAKPU
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 COLFAX AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1461
Mailing Address - Country:US
Mailing Address - Phone:763-316-7900
Mailing Address - Fax:
Practice Address - Street 1:2934 COLFAX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1461
Practice Address - Country:US
Practice Address - Phone:763-316-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN380622172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN380622OtherMINNESOTA DEPARTMENT OF TRANSPORTATION (MNDOT)