Individual
ANDREA E IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
12800 BOENKER LN, BRIDGETON, MO 63044-2438
(314) 551-0338
(314) 551-0336
Mailing address
12800 BOENKER LN, BRIDGETON, MO 63044-2438
(314) 551-0338
(314) 551-0336
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
137743
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429398209
—
MO
Enumeration date
05/12/2006
Last updated
07/14/2014
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