Provider Demographics
NPI:1740918697
Name:OKOLO, STEPHEN (APRN/CNP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:OKOLO
Suffix:
Gender:M
Credentials:APRN/CNP
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Other - First Name:
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Mailing Address - Street 1:12395 MCCRACKEN RD STE H
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2946
Mailing Address - Country:US
Mailing Address - Phone:216-587-6727
Mailing Address - Fax:844-887-5003
Practice Address - Street 1:3364 KOLBE RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1628
Practice Address - Country:US
Practice Address - Phone:440-960-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health