Provider Demographics
NPI:1619460201
Name:SASA, IKAMI A B (ARNP)
Entity Type:Individual
Prefix:
First Name:IKAMI
Middle Name:A B
Last Name:SASA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-248-0037
Mailing Address - Fax:319-248-0168
Practice Address - Street 1:2055 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-4704
Practice Address - Country:US
Practice Address - Phone:319-248-0037
Practice Address - Fax:319-248-0168
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG105815363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0074575Medicaid