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NPI Code Detail

MEDICARE: MRS. BLESSING ADA IKONNE NP- C

MEDICARE: MRS. BLESSING ADA IKONNE NP- C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN197583GA

General Provider Information

NPI Number : 1780091983
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BLESSING ADA IKONNE NP- C
Provider Business Mailing Address
First Line : 634 EXCALIBUR CT SE
Second Line :
City : MABLETON
State : GA
Zip : 30126-4699
Country : US
Telephone Number : 574-386-4030
Fax Number :
Provider Business Practice Location Address
First Line : 2994 ATLANTA RD SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-3655
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2014
Last Update Date : 11/10/2014

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