Provider Demographics
NPI:1760699490
Name:IKOTT, MAGDALENE WILLIAMS
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENE
Middle Name:WILLIAMS
Last Name:IKOTT
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 1:1303 RENE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5354
Mailing Address - Country:US
Mailing Address - Phone:281-736-9962
Mailing Address - Fax:281-736-9962
Practice Address - Street 1:1303 RENE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5354
Practice Address - Country:US
Practice Address - Phone:281-491-0607
Practice Address - Fax:281-491-0607
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644603163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220040398Medicaid