Provider Demographics
NPI:1699594457
Name:OKALA, IVIAN C (RN)
Entity type:Individual
Prefix:
First Name:IVIAN
Middle Name:C
Last Name:OKALA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IVIAN
Other - Middle Name:C
Other - Last Name:OKORODUDU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13320 COUNTRY WALK CT
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2368
Mailing Address - Country:US
Mailing Address - Phone:734-383-0740
Mailing Address - Fax:
Practice Address - Street 1:13320 COUNTRY WALK CT
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-2368
Practice Address - Country:US
Practice Address - Phone:734-383-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704383676163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult