| NPI | 1124280953 |
|---|---|
| Former Name | HEATHER HENSLEY IVY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 011291) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 83764) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-12-27 |