Individual
BRENDA REBECCA IKWAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
19250 SW 65TH AVE STE 235, TUALATIN, OR 97062-7745
(503) 692-5650
(503) 692-7903
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD221309
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2136113
—
WA
05
—
500765006
—
OR
Enumeration date
03/18/2019
Last updated
12/19/2024
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