Individual
IVY ELIZABETH DEEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4740 PEACH ST, ERIE, PA 16509-2008
(814) 454-3174
(814) 616-8002
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2507
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP025602
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN682711
MEDICAL LICENSE
PA
01
—
SP025602
MEDICAL LICENSE
PA
Enumeration date
05/13/2022
Last updated
05/13/2022
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