Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 8261 | MN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 8261 | MN |
NPI | 1083285621 |
---|---|
Provider Name | Resley Okioma |
First Address | Minneapolis, MN 55404-2557 |
Second Address | Minneapolis,, MN 55404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2021 |
Last Update Date | 10/08/2021 |