Provider Demographics
NPI:1811662323
Name:IBUDE, CYNTHIA KIKANWA (RN)
Entity type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:KIKANWA
Last Name:IBUDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4942 BERKELEY OAK CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4959
Mailing Address - Country:US
Mailing Address - Phone:404-916-9641
Mailing Address - Fax:
Practice Address - Street 1:1607 BARRINGTON VW
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1846
Practice Address - Country:US
Practice Address - Phone:404-702-9821
Practice Address - Fax:678-705-3735
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254977163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse