Provider Demographics
NPI:1235247461
Name:OKORO, THERESA (CNM)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:OKORO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MILLS AVE STE 200
Mailing Address - Street 2:105 MILLS AVE. STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4169
Mailing Address - Country:US
Mailing Address - Phone:505-454-1109
Mailing Address - Fax:505-454-1779
Practice Address - Street 1:105 MILLS AVE STE 200
Practice Address - Street 2:105 MILLS AVE. STE. 200
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4169
Practice Address - Country:US
Practice Address - Phone:505-454-1109
Practice Address - Fax:505-454-1779
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR27113207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM49225022Medicaid
NMQ21560Medicare UPIN