Provider Demographics
NPI:1346267770
Name:OKORO, EUNICE (NP)
Entity Type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:
Last Name:OKORO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:ADEUALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8057
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-8057
Mailing Address - Country:US
Mailing Address - Phone:703-509-8028
Mailing Address - Fax:703-569-8085
Practice Address - Street 1:7011 CALAMO ST
Practice Address - Street 2:STE 105
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3500
Practice Address - Country:US
Practice Address - Phone:703-569-8028
Practice Address - Fax:703-569-8085
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR132487363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC490745Medicare ID - Type Unspecified