Provider Demographics
NPI:1558772822
Name:OKAGU, DRIEMONNETTA ILENE (LPN)
Entity Type:Individual
Prefix:
First Name:DRIEMONNETTA
Middle Name:ILENE
Last Name:OKAGU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 E 146TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-3315
Mailing Address - Country:US
Mailing Address - Phone:216-375-6210
Mailing Address - Fax:
Practice Address - Street 1:1069 E 146TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3315
Practice Address - Country:US
Practice Address - Phone:216-375-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN155279M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse