Provider Demographics
NPI:1932312451
Name:PRIMERA, IVA FRANCES (RN,OCN)
Entity Type:Individual
Prefix:
First Name:IVA
Middle Name:FRANCES
Last Name:PRIMERA
Suffix:
Gender:F
Credentials:RN,OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CHINOOK AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1923
Mailing Address - Country:US
Mailing Address - Phone:907-345-5951
Mailing Address - Fax:
Practice Address - Street 1:3101 PENLAND PKWY
Practice Address - Street 2:J-11
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1906
Practice Address - Country:US
Practice Address - Phone:907-279-8055
Practice Address - Fax:907-279-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5879163W00000X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy