Provider Demographics
NPI:1154741551
Name:OKEKE, LATIFAT (NP)
Entity type:Individual
Prefix:MS
First Name:LATIFAT
Middle Name:
Last Name:OKEKE
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 1:341 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4113
Mailing Address - Country:US
Mailing Address - Phone:914-434-4964
Mailing Address - Fax:
Practice Address - Street 1:49-04 19TH AVE,
Practice Address - Street 2:RIKERS ISLAND CORRECTIONAL FACILITY
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105
Practice Address - Country:US
Practice Address - Phone:347-774-7295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401538-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health