Provider Demographics
NPI:1578012548
Name:OKONKWO, EPHRAIM PATRICK
Entity Type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:PATRICK
Last Name:OKONKWO
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 1:15732 ERWIN CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2632
Mailing Address - Country:US
Mailing Address - Phone:301-996-2594
Mailing Address - Fax:
Practice Address - Street 1:15732 ERWIN CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2632
Practice Address - Country:US
Practice Address - Phone:301-996-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12450374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide