Provider Demographics
NPI:1003635293
Name:OKEREKE, PHOEBE VERTIA (LPN)
Entity type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:VERTIA
Last Name:OKEREKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1935
Mailing Address - Country:US
Mailing Address - Phone:716-994-4960
Mailing Address - Fax:
Practice Address - Street 1:25 HOYT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1935
Practice Address - Country:US
Practice Address - Phone:716-994-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty