Provider Demographics
NPI:1275227324
Name:OKON, TITY ETIM
Entity Type:Individual
Prefix:
First Name:TITY ETIM
Middle Name:
Last Name:OKON
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 1:7308 POWHATAN ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1234
Mailing Address - Country:US
Mailing Address - Phone:202-813-7510
Mailing Address - Fax:
Practice Address - Street 1:7308 POWHATAN ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1234
Practice Address - Country:US
Practice Address - Phone:202-813-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide