Individual
MS. WANDA IKEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
499 GLOSTER CREEK VLG STE A2, TUPELO, MS 38801-4749
(662) 620-6800
(662) 377-2403
Mailing address
PO BOX 3488, TUPELO, MS 38803-3488
(662) 377-2949
(662) 377-2403
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R696196
MS
Other
Enumeration date
06/28/2007
Last updated
03/17/2018
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