Provider Demographics
NPI:1568006195
Name:OKAFO, CORDELIA C
Entity Type:Individual
Prefix:MRS
First Name:CORDELIA
Middle Name:C
Last Name:OKAFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 W LYONS ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4124
Mailing Address - Country:US
Mailing Address - Phone:224-595-7393
Mailing Address - Fax:
Practice Address - Street 1:5352 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2316
Practice Address - Country:US
Practice Address - Phone:773-353-5047
Practice Address - Fax:773-353-2406
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018683363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner