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General NPI Number Information
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NPI Number | 1770983223
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Entity Type | Individual
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Provider Name | IVY NGENE LVN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 735 W 157TH ST
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City | GARDENA
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State | CA
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Zip | 90247-4220
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Country | US
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Telephone | 310-590-8740
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Fax | 310-532-0719
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Provider Business Mailing Address
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Address Line | 735 W 157TH STREET
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City | GARDENA
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State | CA
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Zip | 90247-4220
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Country | US
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Telephone | 310-590-8740
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Fax | 310-532-0719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 283094
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License Number State | CA
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