Maple Psychiatry

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

Legal business name

MAPLE PSYCHIATRY

Practice address

1873 Shryer Ave W
Roseville, MN 55113-5413

Phone

(425) 446-0012

NPI assigned

Dec 15, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nicole Burkette Ikebata, MD, MPHNPI 1972964849

Title

Psychiatrist

Phone

(425) 446-0012

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole S Burkette Ikebata, MD, MPH

  • Psychiatry Physician
  • Roseville, MN
  • NPI 1972964849
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1702598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1194593566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 N CEDAR AVE STE 1",
            "city": "OWATONNA",
            "state": "MN",
            "postal_code": "550602306",
            "telephone_number": "425-446-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1873 SHRYER AVE W",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551135413",
            "telephone_number": "425-446-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "BURKETTE IKEBATA",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "425-446-0012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Marie Makousky
• Stephanie Anne Mallak, R.N.
• Courtnie Mann
• Patty-Jo Katherine Mantel, DNP
• Christine Lee Manthey, MA, LPC
• Michael Marcum, LADC
• Brian Scott Martell, M.D.
• Sharon Mason, M.A. L.P.
• Hassan Mohamed Fouad Masroujeh, DMD
• Cheryl Kay Matascastillo, L.M.F.T.

• Child & Adolescent Psychiatry Physician in Roseville, MN
• Providers in Roseville, MN by specialty
• Child & Adolescent Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.