Provider Demographics
NPI:1639567183
Name:IVY, ALLISON (RN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:IVY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BRIDGE VIEW DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-7488
Mailing Address - Country:US
Mailing Address - Phone:843-579-4530
Mailing Address - Fax:843-525-4075
Practice Address - Street 1:4050 BRIDGE VIEW DR
Practice Address - Street 2:SUITE 600
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7488
Practice Address - Country:US
Practice Address - Phone:843-579-4530
Practice Address - Fax:843-525-4075
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC223463163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator