NPIMap

Organization Active NPI

Ivy Wellness Care LLC

Doing business as Ivy Wellness Care

  • Nurse Practitioner
  • Glenside, PA
National Provider Identifier
1902522899
Registry record updated Dec 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
IVY WELLNESS CARE LLC
Doing business as
Ivy Wellness Care
Practice address
712 Fitzwatertown Rd
Glenside, PA 19038-1306
Phone
(215) 885-1112
NPI assigned
Oct 13, 2022
Last updated
Dec 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2022

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

Authorized official

Name
Michele ButlerNPI 1841788957
Title
Nurse Practitioner
Phone
(215) 264-8104

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

712 Fitzwatertown Rd
Glenside, PA 19038-1306

Mailing address

712 Fitzwatertown Rd
Glenside, PA 19038-1306

Other practice location 1

712 Fitzwatertown Rd
Glenside, PA 19038-1306
Phone (215) 885-1112

Other names 1

  • Ivy Wellness Care Doing business as

National Provider Directory

National Provider Directory

Locations

1003 Easton Rd
Ste 106
Willow Grove, PA 19090
Phone (215) 657-7884

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672444800000",
    "number": "1902522899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 FITZWATERTOWN RD",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190381306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 FITZWATERTOWN RD",
            "city": "GLENSIDE",
            "state": "PA",
            "postal_code": "190381306",
            "telephone_number": "215-885-1112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "712 Fitzwatertown Rd",
            "address_purpose": "LOCATION",
            "city": "Glenside",
            "state": "PA",
            "postal_code": "190381306",
            "country_code": "US",
            "telephone_number": "215-885-1112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IVY WELLNESS CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-12-31",
        "certification_date": "2022-12-31",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "215-264-8104"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ivy Wellness Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ivy Wellness Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenside, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.