Provider Demographics
NPI:1285940213
Name:MCILVAINE, JOY A (ANP-BC, LAC)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:A
Last Name:MCILVAINE
Suffix:
Gender:F
Credentials:ANP-BC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 E 7TH ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-6071
Mailing Address - Country:US
Mailing Address - Phone:917-645-2500
Mailing Address - Fax:
Practice Address - Street 1:283 E 7TH ST APT 3C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6071
Practice Address - Country:US
Practice Address - Phone:917-645-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3772171100000X
NYF305363363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No171100000XOther Service ProvidersAcupuncturist