Provider Demographics
NPI:1598384265
Name:IVY LEAF HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:IVY LEAF HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CRNP, FNP-C
Authorized Official - Phone:334-303-8960
Mailing Address - Street 1:5585 PARK SIDE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5124
Mailing Address - Country:US
Mailing Address - Phone:334-303-8960
Mailing Address - Fax:727-202-9651
Practice Address - Street 1:5585 PARK SIDE CIR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-5124
Practice Address - Country:US
Practice Address - Phone:334-303-8960
Practice Address - Fax:727-202-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center