Provider Demographics
NPI:1417620162
Name:IKPATT, EMEM T (NP)
Entity Type:Individual
Prefix:
First Name:EMEM
Middle Name:T
Last Name:IKPATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WELLESLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1859
Mailing Address - Country:US
Mailing Address - Phone:505-841-4108
Mailing Address - Fax:
Practice Address - Street 1:2400 WELLESLEY DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1859
Practice Address - Country:US
Practice Address - Phone:505-841-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048627363LW0102X
NM64628363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health