Idicula, Mimi Song

Idicula, Mimi Song is an individual health care provider with primary practice located at 6161 N State Highway 161 , Irving TX 75038-2220. She recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Chiropractor, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Idicula, Mimi Song can be contacted via phone (972) 258-7499.

Contact Information

Primary practice address
6161 N State Highway 161 Irving TX 75038-2220
Phone: (972) 258-7499
Fax: (972) 257-0897
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 10049 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP137449 Texas

Profile Details

NPI number 1003009580
LBN Legal business name Idicula, Mimi Song
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2007
Last updated Jul 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003009580 NPPES
Texas Other AP137449 NURSE PRACTITIONER

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