MEDICARE: IKPONMWOSA FRANCES ITUA MSN

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	R52475	ND

General Provider Information

NPI Number	:	1073468336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IKPONMWOSA FRANCES ITUA MSN

Provider Business Mailing Address
First Line	:	941 28TH AVE W
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8455
Country	:	US
Telephone Number	:	929-532-5066
Fax Number	:

Provider Business Practice Location Address
First Line	:	941 28TH AVE W
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8455
Country	:	US
Telephone Number	:	929-532-5066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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