Provider Demographics
NPI:1356951644
Name:OKORO, JULIANA NWAKAEGO (RN)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:NWAKAEGO
Last Name:OKORO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SILVER LAKE RD NW STE 7
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-9307
Mailing Address - Country:US
Mailing Address - Phone:165-127-8992
Mailing Address - Fax:612-212-4891
Practice Address - Street 1:1401 SILVER LAKE RD NW STE 7
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-9307
Practice Address - Country:US
Practice Address - Phone:165-127-8992
Practice Address - Fax:612-212-4891
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136669-1163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse