Provider Demographics
NPI:1164231627
Name:OKARI, FREDRICK KIROCHI
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:KIROCHI
Last Name:OKARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 AUGUST DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-7740
Mailing Address - Country:US
Mailing Address - Phone:952-564-5165
Mailing Address - Fax:
Practice Address - Street 1:1674 AUGUST DR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-7740
Practice Address - Country:US
Practice Address - Phone:952-564-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN789075164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse