Individual
MS. IVY MUTIBURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
240 E 38TH ST, NEW YORK, NY 10016-2708
(646) 501-7652
Mailing address
240 E 38TH ST, NEW YORK, NY 10016-2708
(646) 501-7652
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F311010-01
NY
Other
Enumeration date
01/23/2023
Last updated
01/23/2026
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