Provider Demographics
NPI:1275311581
Name:NEELY, IVANNA DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:IVANNA
Middle Name:DANIELLE
Last Name:NEELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IVANNA
Other - Middle Name:DANIELLE
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:304 HADDINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 HECKLE BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2853
Practice Address - Country:US
Practice Address - Phone:803-414-5597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC250470163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health