NPI 1003009580

Mimi Song Idicula, NP

Practitioner Nurse Practitioner Irving, TX

Practice location

Address: 6161 N State Highway 161, Irving, TX 75038-2220
Phone: (972) 258-7499
Fax: (972) 257-0897

Registered specialties (2)

Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363L00000X Licence AP137449 (TX)

Other Nurse Practitioner providers in Texas →

Chiropractor

Chiropractic Providers Taxonomy 111N00000X Licence 10049 (TX)

Other Chiropractor providers in Texas →

Registry record

NPI: 1003009580
Entity type: Individual
Sex (as registered): Female
NPI issued: 20 Aug 2007
Record last updated: 13 Jul 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.