Provider Demographics
NPI:1063791739
Name:IVEY, FLORA MAE (RN)
Entity type:Individual
Prefix:MISS
First Name:FLORA
Middle Name:MAE
Last Name:IVEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8167 EISENHOWER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052-3219
Mailing Address - Country:US
Mailing Address - Phone:478-935-9131
Mailing Address - Fax:478-475-1351
Practice Address - Street 1:8167 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052-3219
Practice Address - Country:US
Practice Address - Phone:478-935-9131
Practice Address - Fax:478-475-1351
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN081301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse