| Doctor Name: | IVY MCKENZIE CARSON |
| NPI Number: | 1023409034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 4704279990 |
| Business Practice Address: | 39242 Dequindre Rd Ste 103 Sterling Heights, MI - 483101764 |
| Business Phone Number: | 5867953600 |
| Business Fax Number: | 5867955446 |
| Mailing Address: | 39242 Dequindre Rd, Ste 103 STERLING HEIGHTS |
| State: | MI |
| Postal Code: | 483101764 |
| Phone Number: | 5867953600 |
| Fax Number: | 5867955446 |
| NPI Enumeration Date: | 02/12/2015 |
| NPI Last Update Date: | 02/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704279990 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |