Basic Information
| Provider Information | |||||||||
| NPI: | 1659537819 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISBEE | ||||||||
| FirstName: | IKUMI | ||||||||
| MiddleName: | HIRASHIMA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 JUNIPER RIDGE BLVD | ||||||||
| Address2: | APT 179 | ||||||||
| City: | COALINGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932109268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599351876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2455 W. JAYNE AVE. | ||||||||
| Address2: | |||||||||
| City: | COALINGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599354300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 670728 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.