Provider Demographics
NPI:1003316712
Name:OKEH, GREG NNAEMEKA
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:NNAEMEKA
Last Name:OKEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 WOODMEADOW PKWY APT 312
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-8561
Mailing Address - Country:US
Mailing Address - Phone:708-257-5076
Mailing Address - Fax:
Practice Address - Street 1:11110 WOODMEADOW PKWY APT 312
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-8561
Practice Address - Country:US
Practice Address - Phone:708-257-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312496164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34302040OtherDRIVER LICENSE