Healthcare Provider Details

I. General information

NPI: 1689452807
Provider Name (Legal Business Name): VICTORIA OGECHI OKOANINNEJI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 CANDLEFIRE DR
REYNOLDSBURG OH
43068-5303
US

IV. Provider business mailing address

3284 CANDLEFIRE DR
REYNOLDSBURG OH
43068-5303
US

V. Phone/Fax

Practice location:
  • Phone: 614-371-2414
  • Fax:
Mailing address:
  • Phone: 614-371-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0034937
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0034937
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: