Provider Demographics
NPI:1093270852
Name:HARPER, IVY R (BSN,RN)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:R
Last Name:HARPER
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 KATHERINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5826
Mailing Address - Country:US
Mailing Address - Phone:404-207-8575
Mailing Address - Fax:
Practice Address - Street 1:3017 KATHERINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5826
Practice Address - Country:US
Practice Address - Phone:404-207-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273051163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management