Provider Demographics
NPI:1457520074
Name:OKOREEH-KANGAH, BEATRICE
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:OKOREEH-KANGAH
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 1:3606 HIGHLAND AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-2608
Mailing Address - Country:US
Mailing Address - Phone:612-659-7111
Mailing Address - Fax:
Practice Address - Street 1:3606 HIGHLAND AVE STE 108
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2608
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily