Provider Demographics
NPI:1922860121
Name:IDEHEN, VICTORIA OFURE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:OFURE
Last Name:IDEHEN
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:OFURE
Other - Last Name:IDUBOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4778 CHALK FLTS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-7141
Mailing Address - Country:US
Mailing Address - Phone:210-209-7721
Mailing Address - Fax:
Practice Address - Street 1:8414 FOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2387
Practice Address - Country:US
Practice Address - Phone:210-277-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134769363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner