Provider Demographics
NPI:1043255664
Name:HALGREN, VICTORIA L (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:L
Last Name:HALGREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15948 YATES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2434
Mailing Address - Country:US
Mailing Address - Phone:402-493-0355
Mailing Address - Fax:
Practice Address - Street 1:8630 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1639
Practice Address - Country:US
Practice Address - Phone:402-898-5600
Practice Address - Fax:402-898-5605
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEG64296Medicare UPIN
NE275588Medicare ID - Type Unspecified