Basic Information
Provider Information
NPI: 1033695531
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKEM
FirstName: VICTORY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: WHNP
OtherOrganizationName:  
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Mailing Information
Address1: 1661 E. CAMELBACK ROAD
Address2: SUITE 200
City: PHOENIX
State: AZ
PostalCode: 850163913
CountryCode: US
TelephoneNumber: 6024229000
FaxNumber: 6025565951
Practice Location
Address1: 485 S. DOBSON ROAD
Address2: SUITE 200
City: CHANDLER
State: AZ
PostalCode: 852245602
CountryCode: US
TelephoneNumber: 4807820993
FaxNumber: 8333370386
Other Information
ProviderEnumerationDate: 07/17/2018
LastUpdateDate: 09/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102XAP11539AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health

No ID Information.


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