Provider Demographics
NPI:1568288496
Name:IVY, PAIGE MICHELLE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MICHELLE
Last Name:IVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 OAK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6844 N US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:POLLOK
Practice Address - State:TX
Practice Address - Zip Code:75969-4548
Practice Address - Country:US
Practice Address - Phone:936-634-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX878916163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management