Provider Demographics
NPI:1407942923
Name:IVES, DONALD ALBERT (FNP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:ALBERT
Last Name:IVES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21408 S HIGHWAY 211
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97017-9435
Mailing Address - Country:US
Mailing Address - Phone:503-754-3815
Mailing Address - Fax:334-529-9609
Practice Address - Street 1:21408 S HIGHWAY 211
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:OR
Practice Address - Zip Code:97017-9435
Practice Address - Country:US
Practice Address - Phone:503-754-3815
Practice Address - Fax:334-529-9609
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250031NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR097000774OtherOSBN