Provider Demographics
NPI:1437911732
Name:IVEY, DONELLA REWSCHELLE
Entity Type:Individual
Prefix:
First Name:DONELLA
Middle Name:REWSCHELLE
Last Name:IVEY
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 1:1223 DOBY SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3399
Mailing Address - Country:US
Mailing Address - Phone:704-400-2313
Mailing Address - Fax:
Practice Address - Street 1:1223 DOBY SPRINGS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3399
Practice Address - Country:US
Practice Address - Phone:704-400-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)