Provider Demographics
NPI:1093015109
Name:IVIE, NINA RUTH (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:RUTH
Last Name:IVIE
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:RUTH
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MANNING DRIVE
Mailing Address - Street 2:OCCUPATIONAL HEALTH SERVICE
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-4489
Mailing Address - Fax:984-974-7414
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:OCCUPATIONAL HEALTH SERVICE
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:984-974-4489
Practice Address - Fax:984-974-7414
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNP APPROVAL #5004932363L00000X
NC5004932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004638Medicaid
NC2595033Medicare PIN