Provider Demographics
NPI:1184045361
Name:OKORO, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:OKORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:UCHENNA
Other - Middle Name:CHARLES
Other - Last Name:OKORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2945 SAND DOLLAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7724
Mailing Address - Country:US
Mailing Address - Phone:614-209-6070
Mailing Address - Fax:
Practice Address - Street 1:2945 SAND DOLLAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7724
Practice Address - Country:US
Practice Address - Phone:614-209-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 128189 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse