Provider Demographics
NPI:1386898500
Name:IVORY, MARY O'SULLIVAN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:O'SULLIVAN
Last Name:IVORY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 ANTHWYN RD
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2301
Mailing Address - Country:US
Mailing Address - Phone:610-667-7984
Mailing Address - Fax:
Practice Address - Street 1:437 ANTHWYN RD
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2301
Practice Address - Country:US
Practice Address - Phone:610-667-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010004363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics