| NPI | 1063465482 |
|---|---|
| Other Name | MISTY ANN IVY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS r860233) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN apn11904) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2017-11-28 |