Provider Demographics
NPI:1316404155
Name:IVERY, ANGEL SHERSE
Entity Type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:SHERSE
Last Name:IVERY
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 1:616 W CAMPANELLA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-5116
Mailing Address - Country:US
Mailing Address - Phone:860-985-0000
Mailing Address - Fax:
Practice Address - Street 1:616 W CAMPANELLA DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-5116
Practice Address - Country:US
Practice Address - Phone:860-985-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC247485163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse