MIMI SONG IDICULA — Medicare Enrolled Provider (PRACTITIONER - NURSE PRACTITIONER, TX)
MIMI SONG IDICULA — Medicare Enrolled Provider (PRACTITIONER - NURSE PRACTITIONER, TX) is one of 9,000 enrolled providers in the MedicareEnroll dataset. Key details — Name: MIMI SONG IDICULA; Type: Individual; NPI: 1003009580.
| Name | MIMI SONG IDICULA |
|---|---|
| Type | Individual |
| NPI | 1003009580 |
| Provider type | PRACTITIONER - NURSE PRACTITIONER |
| State | TX |
| Enrollment ID | I20190628000060 |
| Multiple NPI flag | N |
| Source | CMS Medicare FFS Public Provider Enrollment (PECOS) |
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