Provider Demographics
NPI:1427357771
Name:OKPOR, ROSALINE NGOZI (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSALINE
Middle Name:NGOZI
Last Name:OKPOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 BEACH 61ST ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1856
Mailing Address - Country:US
Mailing Address - Phone:917-400-9573
Mailing Address - Fax:
Practice Address - Street 1:196 BEACH 61ST ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1856
Practice Address - Country:US
Practice Address - Phone:917-400-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295658-1164W00000X, 164X00000X
NY649828163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse