Healthcare Provider Details

I. General information

NPI: 1518772441
Provider Name (Legal Business Name): VICTORIA O OGUNWEMIMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N 8TH ST APT 206
LINCOLN NE
68508-1355
US

IV. Provider business mailing address

3243 CORNHUSKER HWY STE A10
LINCOLN NE
68504-1592
US

V. Phone/Fax

Practice location:
  • Phone: 402-202-8087
  • Fax:
Mailing address:
  • Phone: 402-202-8087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: