Provider Demographics
NPI:1558255802
Name:OKORODUDU, AMONETSONE TRACEY
Entity type:Individual
Prefix:
First Name:AMONETSONE
Middle Name:TRACEY
Last Name:OKORODUDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMONETSONE
Other - Middle Name:TRACEY
Other - Last Name:KOLOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:7047 PARLIAMENT PL
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8325
Mailing Address - Country:US
Mailing Address - Phone:513-293-3001
Mailing Address - Fax:
Practice Address - Street 1:7047 PARLIAMENT PL
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-8325
Practice Address - Country:US
Practice Address - Phone:513-293-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH469030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse