Provider Demographics
NPI:1023126810
Name:OKROI, ANGELA M (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:OKROI
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MEDICAL GROUP
Mailing Address - Street 2:2900 DOOLITTLE DR ELLSWORTH AFB SD
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702
Mailing Address - Country:US
Mailing Address - Phone:605-385-3147
Mailing Address - Fax:
Practice Address - Street 1:28 MEDICAL GROUP
Practice Address - Street 2:2900 DOOLITTLE DR ELLSWORTH AFB SD
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702
Practice Address - Country:US
Practice Address - Phone:605-385-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1071712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN