Provider Demographics
NPI:1396149167
Name:OKOYE, BENEDICTA
Entity type:Individual
Prefix:
First Name:BENEDICTA
Middle Name:
Last Name:OKOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 LOGAN WAY
Mailing Address - Street 2:APT. A3
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1816
Mailing Address - Country:US
Mailing Address - Phone:240-350-1443
Mailing Address - Fax:
Practice Address - Street 1:6001 LOGAN WAY
Practice Address - Street 2:APT. A3
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1816
Practice Address - Country:US
Practice Address - Phone:240-350-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005515164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse