| Doctor Name: | MS. WANDA IKEDA |
| NPI Number: | 1013114677 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ACNP |
| License Number: | R696196 |
| Business Practice Address: | 499 Gloster Creek Vlg Ste A2 Tupelo, MS - 388014749 |
| Business Phone Number: | 6626206800 |
| Business Fax Number: | 6623772403 |
| Mailing Address: | Po Box 3488, TUPELO |
| State: | MS |
| Postal Code: | 388033488 |
| Phone Number: | 6623772949 |
| Fax Number: | 6623772403 |
| NPI Enumeration Date: | 06/28/2007 |
| NPI Last Update Date: | 09/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | R696196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |