Provider Demographics
NPI:1083323919
Name:OKON, JULIANA MOBISOLA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:MOBISOLA
Last Name:OKON
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 1:1 DIETZ CT
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1108
Mailing Address - Country:US
Mailing Address - Phone:857-249-7333
Mailing Address - Fax:
Practice Address - Street 1:1 DIETZ CT # A
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1108
Practice Address - Country:US
Practice Address - Phone:857-249-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2317197163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health