Provider Demographics
NPI:1417086802
Name:IVY, TAMMY LAWLER (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LAWLER
Last Name:IVY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 W CANNING DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9311
Mailing Address - Country:US
Mailing Address - Phone:843-906-3276
Mailing Address - Fax:
Practice Address - Street 1:1375 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3254
Practice Address - Country:US
Practice Address - Phone:843-883-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOR 96158.367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCVAD000Medicare UPIN