Provider Demographics
NPI:1750834495
Name:IVY, LEE ANN R (CNP)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:R
Last Name:IVY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:745 CARTER DR
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1154
Practice Address - Country:US
Practice Address - Phone:567-309-2050
Practice Address - Fax:567-309-2052
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily