Provider Demographics
NPI:1164168316
Name:OKEKE, AMARACHI BLESSING
Entity Type:Individual
Prefix:
First Name:AMARACHI
Middle Name:BLESSING
Last Name:OKEKE
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 1:7009 LACHLAN CIR APT H
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-4531
Mailing Address - Country:US
Mailing Address - Phone:443-460-8684
Mailing Address - Fax:
Practice Address - Street 1:7009 LACHLAN CIR APT H
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-4531
Practice Address - Country:US
Practice Address - Phone:443-460-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR5053251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR5053Medicaid