Individual
IVY SEABURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
535 NE 6TH AVE, ESTACADA, OR 97023-9312
(503) 630-8550
Mailing address
PO BOX 546, GRESHAM, OR 97030-0132
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202107614NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500796235
—
OR
Enumeration date
07/27/2021
Last updated
08/23/2022
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