Provider Demographics
NPI:1689470072
Name:IJIKARAH, MINETTE
Entity type:Individual
Prefix:
First Name:MINETTE
Middle Name:
Last Name:IJIKARAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 BUNCHBERRY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2319
Mailing Address - Country:US
Mailing Address - Phone:661-724-6449
Mailing Address - Fax:
Practice Address - Street 1:15209 BUNCHBERRY CT
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2319
Practice Address - Country:US
Practice Address - Phone:202-468-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse