Provider Demographics
NPI:1720810443
Name:IVEY, BRANDY R
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:R
Last Name:IVEY
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 1:11131 STATE ROUTE 503
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45064-9644
Mailing Address - Country:US
Mailing Address - Phone:513-571-2387
Mailing Address - Fax:
Practice Address - Street 1:11131 STATE ROUTE 503
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45064-9644
Practice Address - Country:US
Practice Address - Phone:513-571-2387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant