Provider Demographics
NPI:1629787031
Name:OKORIE, CALISTA OLUCHI
Entity Type:Individual
Prefix:
First Name:CALISTA OLUCHI
Middle Name:
Last Name:OKORIE
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 1:5101 SARGENT RD NE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2825
Mailing Address - Country:US
Mailing Address - Phone:202-602-9492
Mailing Address - Fax:
Practice Address - Street 1:5101 SARGENT RD NE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2825
Practice Address - Country:US
Practice Address - Phone:202-602-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide