Healthcare Provider Details

I. General information

NPI: 1760293617
Provider Name (Legal Business Name): VICTORY TOTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 2ND AVE NE
OSSEO MN
55369-1108
US

IV. Provider business mailing address

5712 162ND LN NW
RAMSEY MN
55303-3980
US

V. Phone/Fax

Practice location:
  • Phone: 763-325-8368
  • Fax: 763-402-7732
Mailing address:
  • Phone: 612-267-0424
  • Fax: 763-402-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FELICIA C IKEBUDE
Title or Position: PARTNER
Credential: NURSE PRACTITIONER
Phone: 612-267-0424