Healthcare Provider Details

I. General information

NPI: 1275957771
Provider Name (Legal Business Name): FELICIA C IKEBUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA C IKEBUDE

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

5712 162ND LN NW
RAMSEY MN
55303-3980
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-2232
  • Fax:
Mailing address:
  • Phone: 612-267-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR-155858-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: