1285966069 NPI number — MR. IKE ALPHONSUS OKWUONU LPC CANDIDATE

Table of content: MR. IKE ALPHONSUS OKWUONU LPC CANDIDATE (NPI 1285966069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285966069 NPI number — MR. IKE ALPHONSUS OKWUONU LPC CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKWUONU
Provider First Name:
IKE
Provider Middle Name:
ALPHONSUS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC CANDIDATE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKWUONU
Provider Other First Name:
IMELDA
Provider Other Middle Name:
CHINELO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285966069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16500 SUNNY HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73012-6743
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-341-7804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16500 SUNNY HOLLOW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73012-6743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-341-7804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/04/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)