Provider Demographics
NPI:1588030506
Name:OKONKWO, BERNADETTE (NP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:OKONKWO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:OKEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15747 ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0728
Mailing Address - Country:US
Mailing Address - Phone:909-452-4545
Mailing Address - Fax:909-264-1862
Practice Address - Street 1:1003 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3948
Practice Address - Country:US
Practice Address - Phone:909-452-4545
Practice Address - Fax:909-264-1862
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95061465163W00000X
CA95024084363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse