Provider Demographics
NPI:1194032797
Name:OMOKURU, ELOHO
Entity Type:Individual
Prefix:
First Name:ELOHO
Middle Name:
Last Name:OMOKURU
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 1:7563 BLACK SQUIRREL TRL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-7613
Mailing Address - Country:US
Mailing Address - Phone:513-258-3169
Mailing Address - Fax:
Practice Address - Street 1:7563 BLACK SQUIRREL TRL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-7613
Practice Address - Country:US
Practice Address - Phone:513-258-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400403630904376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide