Provider Demographics
NPI:1124226782
Name:OKORO, CONSTANCE IFEOMA (LPN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:IFEOMA
Last Name:OKORO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 BROADVIEW RD
Mailing Address - Street 2:APT 107
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3548
Mailing Address - Country:US
Mailing Address - Phone:216-673-8729
Mailing Address - Fax:
Practice Address - Street 1:5676 BROADVIEW RD
Practice Address - Street 2:APT 107
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44134-3548
Practice Address - Country:US
Practice Address - Phone:216-673-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH119190164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse