Provider Demographics
NPI:1114400066
Name:OKOJIE, OSEREMEN LAURETTA (NP)
Entity type:Individual
Prefix:
First Name:OSEREMEN
Middle Name:LAURETTA
Last Name:OKOJIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CYPRESS GROVE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6703
Mailing Address - Country:US
Mailing Address - Phone:443-768-7995
Mailing Address - Fax:
Practice Address - Street 1:4 CYPRESS GROVE CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6703
Practice Address - Country:US
Practice Address - Phone:443-768-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily