Provider Demographics
NPI:1154834828
Name:MATE-KOLE, VICTORIA MANKUBURIGI (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:MANKUBURIGI
Last Name:MATE-KOLE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11816 NW 134TH ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-3004
Mailing Address - Country:US
Mailing Address - Phone:405-474-6854
Mailing Address - Fax:
Practice Address - Street 1:11816 NW 134TH ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-3004
Practice Address - Country:US
Practice Address - Phone:405-474-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK95325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty