Provider Demographics
NPI:1649007493
Name:OYAIRO, IVY I
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:I
Last Name:OYAIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114A SUTHERLIN DR # 3105
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2259
Mailing Address - Country:US
Mailing Address - Phone:951-990-7774
Mailing Address - Fax:
Practice Address - Street 1:114A SUTHERLIN DR # 3105
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2259
Practice Address - Country:US
Practice Address - Phone:951-990-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program