Provider Demographics
NPI:1508446931
Name:OKPOLOKPO, MICHAEL OTHUKE (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OTHUKE
Last Name:OKPOLOKPO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BARNACLE GEESE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7102
Mailing Address - Country:US
Mailing Address - Phone:443-983-8465
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1531
Practice Address - Country:US
Practice Address - Phone:443-983-8465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY807340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse