Provider Demographics
NPI:1700621539
Name:OKOLIE, CHUKWUKA JEROME
Entity type:Individual
Prefix:
First Name:CHUKWUKA
Middle Name:JEROME
Last Name:OKOLIE
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 1:6132 85TH PL
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2844
Mailing Address - Country:US
Mailing Address - Phone:202-391-4020
Mailing Address - Fax:
Practice Address - Street 1:6132 85TH PL
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-2844
Practice Address - Country:US
Practice Address - Phone:202-391-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide