Provider Demographics
NPI:1710461587
Name:OKOH, OLISADUMBI (RN)
Entity Type:Individual
Prefix:MS
First Name:OLISADUMBI
Middle Name:
Last Name:OKOH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1336
Mailing Address - Country:US
Mailing Address - Phone:610-896-4924
Mailing Address - Fax:610-896-1090
Practice Address - Street 1:370 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1336
Practice Address - Country:US
Practice Address - Phone:610-896-4924
Practice Address - Fax:610-896-1090
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN691521163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty