Provider Demographics
NPI:1144377748
Name:IVORY, JOANN DICOSIMO (RN,C)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:DICOSIMO
Last Name:IVORY
Suffix:
Gender:F
Credentials:RN,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 COUPON GALLITZIN RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16613-8527
Mailing Address - Country:US
Mailing Address - Phone:814-946-8767
Mailing Address - Fax:
Practice Address - Street 1:500 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5215
Practice Address - Country:US
Practice Address - Phone:814-946-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN243608L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse