Provider Demographics
NPI:1821827106
Name:IKPEA, GEORGINA O (MSC,APRN,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:O
Last Name:IKPEA
Suffix:
Gender:F
Credentials:MSC,APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 CARRON DR APT 174
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3536
Mailing Address - Country:US
Mailing Address - Phone:657-281-8345
Mailing Address - Fax:
Practice Address - Street 1:1350 JACKIE RD SE STE 104
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1519
Practice Address - Country:US
Practice Address - Phone:505-515-3982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health