Provider Demographics
NPI:1417471269
Name:OKORO, OSAZE ERNEST (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:OSAZE
Middle Name:ERNEST
Last Name:OKORO
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10482 BALTIMORE AVE UNIT 324
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2321
Mailing Address - Country:US
Mailing Address - Phone:443-557-8719
Mailing Address - Fax:
Practice Address - Street 1:90 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688
Practice Address - Country:US
Practice Address - Phone:667-367-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2023-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203391363LP0808X
OHRN.353695363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD888493500Medicaid
2017001817OtherANCC CLINICIAN CERTIFICATION NUMBER
MDMD-10272602722OtherDRIVER LICENSE
OHSJ125449OtherDRIVER LICENSE