Provider Demographics
NPI:1265118814
Name:OKU, EVERLOVE
Entity type:Individual
Prefix:
First Name:EVERLOVE
Middle Name:
Last Name:OKU
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 1:5600 LANGSTON BLVD APT 406
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1458
Mailing Address - Country:US
Mailing Address - Phone:571-341-0035
Mailing Address - Fax:
Practice Address - Street 1:5600 LANGSTON BLVD APT 406
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1458
Practice Address - Country:US
Practice Address - Phone:571-341-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002077426164W00000X
171M00000X
DC1008119164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator