Organization
MAPLE PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE BURKETTE IKEBATA MD, MPH (PSYCHIATRIST)
(425) 446-0012
Entity
Organization
Contact information
Practice address
1873 SHRYER AVE W, ROSEVILLE, MN 55113-5413
(425) 446-0012
Mailing address
202 N CEDAR AVE STE 1, OWATONNA, MN 55060-2306
(425) 446-0012
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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