Provider Demographics
NPI:1548035637
Name:NDEMATEBEM, VICTORINE ANKONGBE
Entity type:Individual
Prefix:
First Name:VICTORINE
Middle Name:ANKONGBE
Last Name:NDEMATEBEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 DUGAN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7124
Mailing Address - Country:US
Mailing Address - Phone:614-657-5157
Mailing Address - Fax:
Practice Address - Street 1:735 DUGAN RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7124
Practice Address - Country:US
Practice Address - Phone:614-657-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF11230307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily