Healthcare Provider Details

I. General information

NPI: 1619460201
Provider Name (Legal Business Name): IKAMI A B SASA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

IV. Provider business mailing address

2277 IOWA AVE
INDEPENDENCE IA
50644-9106
US

V. Phone/Fax

Practice location:
  • Phone: 319-334-2583
  • Fax: 319-334-5402
Mailing address:
  • Phone: 319-334-2583
  • Fax: 319-334-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG105815
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: