Doctor Name: | WILLIAM DAVID IVESON |
NPI Number: | 1205232709 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-BC |
License Number: | SP014480 |
Business Practice Address: | 271 Grand St Susquehanna, PA - 188471511 |
Business Phone Number: | 6072211318 |
Business Fax Number: | 5708533008 |
Mailing Address: | 271 Grand St, SUSQUEHANNA |
State: | PA |
Postal Code: | 188471511 |
Phone Number: | 6072211318 |
Fax Number: | 5708533008 |
NPI Enumeration Date: | 11/10/2014 |
NPI Last Update Date: | 11/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP014480 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |