Provider Demographics
NPI:1316088321
Name:IVEY, ELIZABETH L AVERY (NNP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:L AVERY
Last Name:IVEY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 WAYNOKA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6921
Mailing Address - Country:US
Mailing Address - Phone:901-327-2759
Mailing Address - Fax:
Practice Address - Street 1:3832 WAYNOKA AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6921
Practice Address - Country:US
Practice Address - Phone:901-327-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006041363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal