Provider Demographics
NPI:1124297890
Name:HUNTER-IVERSON, DAISY IRENE (LPN)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:IRENE
Last Name:HUNTER-IVERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 FULTON RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-2351
Mailing Address - Country:US
Mailing Address - Phone:330-452-4846
Mailing Address - Fax:
Practice Address - Street 1:824 FULTON RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2351
Practice Address - Country:US
Practice Address - Phone:330-452-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110682164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse