Provider Demographics
NPI:1083384804
Name:OKOLI, OBIAGELI
Entity Type:Individual
Prefix:
First Name:OBIAGELI
Middle Name:
Last Name:OKOLI
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 1:1140 BENSON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4659
Mailing Address - Country:US
Mailing Address - Phone:862-224-2861
Mailing Address - Fax:
Practice Address - Street 1:1140 BENSON RD STE 201
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4659
Practice Address - Country:US
Practice Address - Phone:862-224-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCOKOL-TPJLY363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner