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General NPI Number Information
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NPI Number | 1518257492
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Entity Type | Individual
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Provider Name | VICTOR IKEMEFULA UKONU HOME HEALTH CARE ADM
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Gender | Male
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 4045 NW 64ST
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City | OKLAHOMA
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State | OK
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Zip | 73116
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Country | US
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Telephone | 405-602-4746
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 720850
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City | OKLAHOMA CITY
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State | OK
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Zip | 73172-1610
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Country | US
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Telephone | 405-602-4746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 37D674350807
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License Number State | OK
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