Provider Demographics
NPI:1396353033
Name:WINDHAM, IKEA (RN)
Entity type:Individual
Prefix:
First Name:IKEA
Middle Name:
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 PIERCE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2425
Mailing Address - Country:US
Mailing Address - Phone:614-223-4650
Mailing Address - Fax:
Practice Address - Street 1:2022 RIVER ROCK WAY
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8259
Practice Address - Country:US
Practice Address - Phone:567-307-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2023-02-22
Deactivation Date:2022-01-14
Deactivation Code:
Reactivation Date:2023-02-22
Provider Licenses
StateLicense IDTaxonomies
OHRN.468495163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty