Provider Demographics
NPI:1255149142
Name:OKANI, IFEOMA ELIZABETH
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:ELIZABETH
Last Name:OKANI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26901
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28221-6901
Mailing Address - Country:US
Mailing Address - Phone:336-999-9197
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 26901
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28221-6901
Practice Address - Country:US
Practice Address - Phone:309-278-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health