Provider Demographics
NPI:1881753580
Name:IVY HURGUY, SHELLEY L (CRNA)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:IVY HURGUY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6514
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91359-6514
Mailing Address - Country:US
Mailing Address - Phone:805-230-2650
Mailing Address - Fax:805-339-1280
Practice Address - Street 1:444 ARNETT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2106
Practice Address - Country:US
Practice Address - Phone:805-765-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA2508367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered