Provider Demographics
NPI:1114293032
Name:BURTON, IVY LADYSE (LVN)
Entity Type:Individual
Prefix:MS
First Name:IVY
Middle Name:LADYSE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E VALLEY PKWY # 212
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2341
Mailing Address - Country:US
Mailing Address - Phone:858-705-8268
Mailing Address - Fax:
Practice Address - Street 1:1310 E VALLEY PKWY # 212
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2341
Practice Address - Country:US
Practice Address - Phone:858-705-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201983164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse