Provider Demographics
NPI:1942808522
Name:MASSIE, IVIE (LVN)
Entity Type:Individual
Prefix:
First Name:IVIE
Middle Name:
Last Name:MASSIE
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 1:7101 WALJIM ST APT 101
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4904
Mailing Address - Country:US
Mailing Address - Phone:936-225-9954
Mailing Address - Fax:
Practice Address - Street 1:7101 WALJIM ST APT 101
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4904
Practice Address - Country:US
Practice Address - Phone:936-225-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013217164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse