Provider Demographics
NPI:1013371335
Name:LERSTEN, IVY L (MD)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:L
Last Name:LERSTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:SHUPENG
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13001 E 17TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2570
Mailing Address - Country:US
Mailing Address - Phone:303-724-2052
Mailing Address - Fax:303-724-2055
Practice Address - Street 1:13001 E 17TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2570
Practice Address - Country:US
Practice Address - Phone:303-724-2052
Practice Address - Fax:303-724-2055
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063987207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology