Provider Demographics
NPI:1578960332
Name:IFEDI, VICTORIA UKAMAKA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:UKAMAKA
Last Name:IFEDI
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 1:16725 WINSTON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5206
Mailing Address - Country:US
Mailing Address - Phone:704-534-1035
Mailing Address - Fax:
Practice Address - Street 1:16725 WINSTON OAKS CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5206
Practice Address - Country:US
Practice Address - Phone:704-534-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC500763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily