Provider Demographics
NPI:1770709107
Name:CAMERON, IVY M (APRN-NP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:M
Last Name:CAMERON
Suffix:
Gender:
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 NW 11TH ST STE M106
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6941
Mailing Address - Country:US
Mailing Address - Phone:541-667-3801
Mailing Address - Fax:541-667-3802
Practice Address - Street 1:620 NW 11TH ST STE M106
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-6941
Practice Address - Country:US
Practice Address - Phone:541-667-3801
Practice Address - Fax:541-667-3802
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10036510363LF0000X, 363LX0001X
WAAP60018518363LX0001X
WARN00071381163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant