Provider Demographics
NPI:1215597596
Name:IVUSIC, MAUREEN D
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:D
Last Name:IVUSIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18400 BILLEK CT
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2510
Mailing Address - Country:US
Mailing Address - Phone:301-514-2105
Mailing Address - Fax:
Practice Address - Street 1:18400 BILLEK CT
Practice Address - Street 2:
Practice Address - City:POOLESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20837-2510
Practice Address - Country:US
Practice Address - Phone:301-514-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty