Healthcare Provider Details

I. General information

NPI: 1285318808
Provider Name (Legal Business Name): IKUMI WINBURN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 SANDRINGHAM WAY
ROSEVILLE CA
95661-5321
US

IV. Provider business mailing address

2440 COTTAGE WAY APT 123
SACRAMENTO CA
95825-1935
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number732680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: