Individual
MRS. NICOLE MARIE IKEDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 LYONS ST, DEPT. OF DERMATOLOGY, DEDHAM, MA 02026
(781) 329-1400
Mailing address
1 LYONS ST, DEPT. OF DERMATOLOGY, DEDHAM, MA 02026
(781) 329-1400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA5670
MA
Other
Enumeration date
09/01/2016
Last updated
12/05/2019
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