Provider Demographics
NPI:1477025401
Name:OKORIE, GODSWILL OGBONNA
Entity Type:Individual
Prefix:
First Name:GODSWILL
Middle Name:OGBONNA
Last Name:OKORIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14122 RED EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6323
Mailing Address - Country:US
Mailing Address - Phone:240-705-4090
Mailing Address - Fax:
Practice Address - Street 1:14122 RED EAGLE LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6323
Practice Address - Country:US
Practice Address - Phone:240-705-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14188374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide