Basic Information
| Provider Information | |||||||||
| NPI: | 1871068684 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKLETEY | ||||||||
| FirstName: | LORNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | CROYDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190216908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404815038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4190 CITY AVE STE 528 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191311635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493661053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2018 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA060198 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.