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1730815960 NPI number — MELLISSA SUE IVY ARNP

NPI Number: 1730815960
Health Care Provider/Practitioner: MELLISSA SUE IVY ARNP

Information about “1730815960” NPI (MELLISSA SUE IVY ARNP) exists in 1730815960 in HTML format HTML  |  1730815960 in plain Text format TXT  |  1730815960 in PDF (Portable Document Format) PDF  |  1730815960 in an XML format XML  formats.

NPI Number : 1730815960 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730815960",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "IVY",
    "FirstName": "MELLISSA",
    "MiddleName": "SUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ARNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WALTER",
    "OtherFirstName": "MELLISSA",
    "OtherMiddleName": "SUE IVY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ARNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 421",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LIBERTY LAKE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99019-0421",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "866-747-2455",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "101 W 8TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPOKANE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99204-2307",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-474-3260",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/29/2022",
    "LastUpdateDate": "05/02/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "61216242",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2100X",
          "TaxonomyName": "Acute Care Nurse Practitioner",
          "LicenseNumber": "AP61216242",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "AP61216242",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "AP61216242",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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