Provider Demographics
NPI:1922763168
Name:IVES, MERRICK MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MERRICK
Middle Name:MARIE
Last Name:IVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9405 FAIRWAY VIEW PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0932
Mailing Address - Country:US
Mailing Address - Phone:909-481-7345
Mailing Address - Fax:
Practice Address - Street 1:9405 FAIRWAY VIEW PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0932
Practice Address - Country:US
Practice Address - Phone:909-481-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA60157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant