Provider Demographics
NPI:1518257492
Name:UKONU, VICTOR IKEMEFULA (HOME HEALTH CARE ADM)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:IKEMEFULA
Last Name:UKONU
Suffix:
Gender:M
Credentials:HOME HEALTH CARE ADM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 720850
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-1610
Mailing Address - Country:US
Mailing Address - Phone:405-602-4746
Mailing Address - Fax:
Practice Address - Street 1:4045 NW 64ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-602-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37D674350807376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator