Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | R27113 | NM |
NPI | 1235247461 |
---|---|
Provider Name | Theresa Okoro |
First Address | Las Vegas, NM 87701-4169 |
Second Address | Las Vegas, NM 87701-4169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49225022 | (05) | NM |
Q21560 | (02) | NM |