Provider Demographics
NPI:1699364620
Name:IKEHARA, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:IKEHARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 COMM PARK LN
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-5490
Mailing Address - Country:US
Mailing Address - Phone:919-346-3350
Mailing Address - Fax:
Practice Address - Street 1:45 COMM PARK LN
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5490
Practice Address - Country:US
Practice Address - Phone:919-346-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist