Healthcare Provider Details

I. General information

NPI: 1093022261
Provider Name (Legal Business Name): UVA DRAKE-IVEY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MADISON AVE
MADISON NJ
07940-1434
US

IV. Provider business mailing address

PO BOX 6002
NEWARK NJ
07106-0002
US

V. Phone/Fax

Practice location:
  • Phone: 973-408-3414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00292900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: