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Individual

MELLISSA SUE IVY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
101 W 8TH AVE, SPOKANE, WA 99204-2307
(509) 474-3260
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
61216242
WA
363LA2100X
Acute Care Nurse Practitioner
AP61216242
WA
363LF0000X
Family Nurse Practitioner
AP61216242
WA
363LG0600X
Gerontology Nurse Practitioner
Primary
AP61216242
WA

Other

Enumeration date
07/29/2022
Last updated
05/02/2024
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