Provider Demographics
NPI:1265864615
Name:OKEMWA, JACQUELINE B (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:B
Last Name:OKEMWA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:B
Other - Last Name:OKEMWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:51 ROOSEVELT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:51 ROOSEVELT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1207
Practice Address - Country:US
Practice Address - Phone:201-889-1494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00448900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health