Individual
WILLIE D IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
601 W 5TH AVE, SUITE 500, SPOKANE, WA 99204-2756
(509) 344-2663
(509) 624-9179
Mailing address
601 W 5TH AVE STE 400, SPOKANE, WA 99204-2715
(509) 344-2663
(509) 624-9179
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN00144573
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147505
REGENCE BLUE SHIELD OF ID
ID
01
—
0185166
DEPT OF LABOR & INDUSTRIE
WA
01
—
192439200
OWCP
WA
01
—
28403
GROUP HEALTH NW
WA
01
—
2855IV
ASURIS NW HEALTH
WA
05
—
4303910
—
MT
05
—
806459700
—
ID
01
—
8938961
CRIME VICTIMS
WA
05
—
9634601
—
WA
01
—
P00126952
RR MEDICARE
WA
Enumeration date
03/14/2006
Last updated
11/15/2024
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