Provider Demographics
NPI:1053596213
Name:IVESTER, DEBBIE S (BOC CMF)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:S
Last Name:IVESTER
Suffix:
Gender:F
Credentials:BOC CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 S NEW HOPE RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-2400
Mailing Address - Country:US
Mailing Address - Phone:704-824-4606
Mailing Address - Fax:704-824-4607
Practice Address - Street 1:3816 S NEW HOPE RD
Practice Address - Street 2:SUITE 18
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-2400
Practice Address - Country:US
Practice Address - Phone:704-824-4606
Practice Address - Fax:704-824-4607
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC36361174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702030Medicaid
NC7702030Medicaid