Healthcare Provider Details

I. General information

NPI: 1770709107
Provider Name (Legal Business Name): IVY M CAMERON APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 11TH ST STE M106
HERMISTON OR
97838-6941
US

IV. Provider business mailing address

620 NW 11TH ST STE M106
HERMISTON OR
97838-6941
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3801
  • Fax: 541-667-3802
Mailing address:
  • Phone: 541-667-3801
  • Fax: 541-667-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10036510
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP60018518
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number10036510
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00071381
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: