Provider Demographics
NPI:1053765479
Name:IVEY, CRISTINA (RN)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRISSY
Other - Middle Name:
Other - Last Name:IVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:64610 BELMONT MORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9719
Mailing Address - Country:US
Mailing Address - Phone:740-509-2686
Mailing Address - Fax:
Practice Address - Street 1:64610 BELMONT MORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718-9719
Practice Address - Country:US
Practice Address - Phone:740-509-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN415885163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse