Provider Demographics
NPI:1922820539
Name:OKWARA, NGOZICHUKWU
Entity type:Individual
Prefix:
First Name:NGOZICHUKWU
Middle Name:
Last Name:OKWARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CANARY RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1602
Mailing Address - Country:US
Mailing Address - Phone:215-910-1870
Mailing Address - Fax:
Practice Address - Street 1:822 KLEMM AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1627
Practice Address - Country:US
Practice Address - Phone:856-237-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-26
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15220800363LP0808X
PASP031096363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty