Provider Demographics
NPI:1134147713
Name:NWAKAMMA-OKORO, NGOZI O (MD)
Entity type:Individual
Prefix:MRS
First Name:NGOZI
Middle Name:O
Last Name:NWAKAMMA-OKORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:
Practice Address - Street 1:960 S COLUMBIA RD - ALTRU CANCER CENTER
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8970207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHP38400OtherHEALTHPARTNERS #
ND27696OtherBLUE CROSS NORTH DAKOTA
MN529L4OKOtherBLUE CROSS MINNESOTA
135582OtherUCARE MN
201200995OtherHUMANA
ND11745Medicaid
978931029653OtherPREFERRED ONE
ND3600716OtherMEDICA
MN923159500Medicaid
NDP00384589OtherRR MEDICARE
201200995OtherUNICARE