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NPI Code Detail

MEDICARE: ROBERT CHARLES IVY RN

MEDICARE: ROBERT CHARLES IVY RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WH0200XHome Health Registered Nurse95320076CA

General Provider Information

NPI Number : 1396604120
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT CHARLES IVY RN
Provider Business Mailing Address
First Line : 78000 FRED WARING DR
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-9266
Country : US
Telephone Number : 888-415-8015
Fax Number :
Provider Business Practice Location Address
First Line : 78000 FRED WARING DR
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-9266
Country : US
Telephone Number : 888-415-8015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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