Ivy, Andrea E

Ivy, Andrea E is an individual health care provider with primary practice located at 12800 Boenker Ln , Bridgeton MO 63044-2438. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Ivy, Andrea E can be contacted via phone (314) 551-0338.

Contact Information

Primary practice address
12800 Boenker Ln Bridgeton MO 63044-2438
Phone: (314) 551-0338
Fax: (314) 551-0336
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 137743 Missouri

Profile Details

NPI number 1649220104
LBN Legal business name Ivy, Andrea E
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jul 14th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649220104 NPPES
Missouri MEDICAID 429398209

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