Provider Demographics
NPI:1194043786
Name:OKOLO, PRISCILLA CHINYERE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:CHINYERE
Last Name:OKOLO
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 1:11932 201ST PL
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3814
Mailing Address - Country:US
Mailing Address - Phone:347-551-9077
Mailing Address - Fax:
Practice Address - Street 1:11932 201ST PL
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3814
Practice Address - Country:US
Practice Address - Phone:347-551-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288514-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse