Provider Demographics
NPI:1578012100
Name:OKORO, PHILOMENA
Entity Type:Individual
Prefix:
First Name:PHILOMENA
Middle Name:
Last Name:OKORO
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 1:7439 LOCK MILL CT
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9465
Mailing Address - Country:US
Mailing Address - Phone:419-410-4309
Mailing Address - Fax:
Practice Address - Street 1:7439 LOCK MILL CT
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9465
Practice Address - Country:US
Practice Address - Phone:419-410-4309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703099273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse