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General NPI Number Information
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NPI Number | 1972964849
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Entity Type | Individual
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Provider Name | NICOLE S BURKETTE IKEBATA MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 03/18/2016
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 2355 HIGHWAY 36 W STE 400
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City | ROSEVILLE
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State | MN
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Zip | 55113-3905
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Country | US
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Telephone | 651-243-8113
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Fax | 931-202-8451
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Provider Business Mailing Address
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Address Line | 2355 HIGHWAY 36 W STE 400
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City | ROSEVILLE
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State | MN
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Zip | 55113-3905
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Country | US
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Telephone | 651-243-8113
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Fax | 931-202-8451
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-55795
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 66384
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DR.0076759
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License Number State | CO
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