Provider Demographics
NPI:1457230542
Name:OKOH, SAMUEL CHINEDU (RN)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHINEDU
Last Name:OKOH
Suffix:
Gender:M
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:PO BOX 1716
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-1716
Mailing Address - Country:US
Mailing Address - Phone:520-688-6767
Mailing Address - Fax:
Practice Address - Street 1:2506 W DUNLAP AVE APT 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2810
Practice Address - Country:US
Practice Address - Phone:520-688-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260727163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse