Provider Demographics
NPI:1184284424
Name:OKPALA, BERNARDINE N
Entity type:Individual
Prefix:
First Name:BERNARDINE
Middle Name:N
Last Name:OKPALA
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 1:5412 RICHARDSONS ENDEAVOR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3395
Mailing Address - Country:US
Mailing Address - Phone:301-256-6971
Mailing Address - Fax:
Practice Address - Street 1:5412 RICHARDSONS ENDEAVOR DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3395
Practice Address - Country:US
Practice Address - Phone:301-256-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1007430363LP0808X
MDR171250363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health