Individual
CHRIS IVY
Active
Individual
CHRIS IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
C02660
AR
367500000X
Certified Registered Nurse Anesthetist
CTP-000039
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165279001
—
AR
01
—
5A372
BCBS AR
AR
01
—
P00440980
RR MEDICARE GROUP CK6327
—
Enumeration date
04/25/2007
Last updated
10/23/2014
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