Organization
IVY INFUSION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESA NICHOLES (OWNER)
(281) 773-7578
Entity
Organization
Contact information
Practice address
1201 CREEK WAY DR STE B, SUGAR LAND, TX 77478-4570
(832) 886-4774
Mailing address
PO BOX 16461, SUGAR LAND, TX 77496-6461
(832) 886-4774
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972766327
NPI
—
Enumeration date
06/15/2017
Last updated
07/21/2022
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