Provider Demographics
NPI:1689177982
Name:IVEY, REBECCA RUTH (LVN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:RUTH
Last Name:IVEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 WOOD HOLLOW DR APT 147R
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3103
Mailing Address - Country:US
Mailing Address - Phone:512-293-5961
Mailing Address - Fax:
Practice Address - Street 1:6805 WOOD HOLLOW DR APT 147R
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3103
Practice Address - Country:US
Practice Address - Phone:512-293-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317818164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse