Healthcare Provider Details

I. General information

NPI: 1073631461
Provider Name (Legal Business Name): NANCY LEE IVERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 BUSKIRK AVE
PLEASANT HILL CA
94523-4316
US

IV. Provider business mailing address

PO BOX 31354
SAN FRANCISCO CA
94131-0354
US

V. Phone/Fax

Practice location:
  • Phone: 925-887-5678
  • Fax: 925-887-5667
Mailing address:
  • Phone: 415-648-3707
  • Fax: 415-648-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC38338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: