Healthcare Provider Details

I. General information

NPI: 1386308955
Provider Name (Legal Business Name): MARSHE IVY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 SHELDON RD
ELK GROVE CA
95758-7345
US

IV. Provider business mailing address

8984 SIERRA ST
ELK GROVE CA
95624-1952
US

V. Phone/Fax

Practice location:
  • Phone: 916-250-1627
  • Fax:
Mailing address:
  • Phone: 510-229-8321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: