Basic Information
| Provider Information | |||||||||
| NPI: | 1508591405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IVES | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6713 ROCKSTREAM DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537195000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205383351 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1211 FISH HATCHERY RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537151909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082528000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2022 | ||||||||
| LastUpdateDate: | 07/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | WI030706701782 | WI | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.