Dustin Brant Ivanic, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP9722 Issued in AZ

Practice address

3255 S Rural Rd
Tempe, AZ 85282-3853

Phone

(480) 304-5467

NPI assigned

Feb 20, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1497294748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 ELM HILL PIKE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372143108",
            "telephone_number": "615-425-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 S RURAL RD",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852823853",
            "telephone_number": "480-304-5467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANIC",
        "first_name": "DUSTIN",
        "middle_name": "BRANT",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP9722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mario-Luis Islas, M.D.
• Brianna M Ison, DSW, LCSW
• Michael Israel
• It's All About You Behavioral Health LLC
• Itech Consulting Partners LLC
• Michael Ivchenko, MD
• Lia Iverson-Tuter, PT, DPT
• Mary Colleen Iverson, SLPA
• Kaitlyn Ives, AU.D.
• Ivy Wellness Services, LLC

• Family Nurse Practitioner in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.