Provider Demographics
NPI:1821556630
Name:ENYINNA-OKORIE, PRECIOUS OBIANUJU
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:OBIANUJU
Last Name:ENYINNA-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 1:6431 PENNSYLVANIA AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3019
Mailing Address - Country:US
Mailing Address - Phone:667-786-0319
Mailing Address - Fax:
Practice Address - Street 1:6431 PENNSYLVANIA AVE APT 201
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-3019
Practice Address - Country:US
Practice Address - Phone:667-786-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14287374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide