Provider Demographics
NPI:1699278960
Name:IKE, CLARA BINTA (RN)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:BINTA
Last Name:IKE
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 1:3850 SAPP RD
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4744
Mailing Address - Country:US
Mailing Address - Phone:832-656-6790
Mailing Address - Fax:
Practice Address - Street 1:3850 SAPP RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4744
Practice Address - Country:US
Practice Address - Phone:832-656-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX557634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse