Larry, Ivory V

Larry, Ivory V is an individual health care provider with primary practice located at 1500 Continental Pl , Mount Vernon WA 98273-4105. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Larry, Ivory V can be contacted via phone (360) 424-7041.

Contact Information

Primary practice address
1500 Continental Pl Mount Vernon WA 98273-4105
Fax: (360) 424-8449
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA10000273 Washington

Profile Details

NPI number 1932109691
LBN Legal business name Larry, Ivory V
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932109691 NPPES
Washington Other 132073 LABOR AND INDUSTRIES

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