Individual
NATASHA L. IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6052 N 59TH AVE, GLENDALE, AZ 85301-7709
(480) 618-0176
(623) 632-0129
Mailing address
PO BOX 746093, ATLANTA, GA 30374-6093
(773) 759-7550
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4401
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232809429021
TRICARE
PA
01
—
50074903
CAPITAL BLUE CROSS
PA
Enumeration date
11/28/2007
Last updated
11/16/2022
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