Provider Demographics
NPI:1629229745
Name:OKEANI, ANTHONIA EJIMOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANTHONIA
Middle Name:EJIMOLE
Last Name:OKEANI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W F ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3262
Mailing Address - Country:US
Mailing Address - Phone:909-391-3222
Mailing Address - Fax:909-391-3288
Practice Address - Street 1:125 W F ST STE 103
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3262
Practice Address - Country:US
Practice Address - Phone:909-391-3222
Practice Address - Fax:909-391-3288
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily