Provider Demographics
NPI:1609062413
Name:OKOLONWAMU, NGOZI ROSEMARY (PA C)
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:ROSEMARY
Last Name:OKOLONWAMU
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE #350
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-615-3750
Mailing Address - Fax:918-615-3751
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE #350
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-615-3750
Practice Address - Fax:918-615-3751
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1633363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical