Provider Demographics
NPI:1851932156
Name:IVIE, NANCY ANN (LPN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:IVIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 S LEE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3710
Mailing Address - Country:US
Mailing Address - Phone:678-765-8160
Mailing Address - Fax:
Practice Address - Street 1:4271 S LEE ST STE 101
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3710
Practice Address - Country:US
Practice Address - Phone:678-765-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN084876163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)