IVAN DAVID NELSON (NPI# 1033686795) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033686795 |
| Entity Type | Individual |
| Full Name | IVAN DAVID NELSON |
| Credential | CPC |
| Practice Address |
748 14th Avenue Longview WA 98632 |
| Mailing Address |
Po Box 2394 Longview WA 98632 |
| Practice Telephone | 3602005419 |
| Practice Fax Number | 3602006736 |
| Mailing Telephone | 3602005419 |
| Mailing Fax Number | 3602006736 |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2020-10-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2155913 | 05 |
| Street Address |
748 14TH AVENUE |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477785541 | Katherine Lora Blackstone Allen | Counselor | 748 14th Avenue, Longview, WA 98632 | 2009-08-21 |
| 1588123228 | Vicky Ilene Coauette-owens | Counselor | 748 14th Avenue, Longview, WA 98632 | 2019-03-12 |
| 1205301017 | Kodee Paul Chase | Counselor | 748 14th Avenue, Longview, WA 98632 | 2018-10-08 |
| 1265939730 | Hollie Burr | Counselor | 748 14th Avenue, Longview, WA 98632 | 2018-04-10 |
| 1306382957 | Constance M Stevenson | Counselor | 748 14th Avenue, Longview, WA 98632 | 2017-01-06 |
| 1982082434 | Timothy Bales | Counselor | 748 14th Avenue, Longview, WA 98632 | 2015-05-15 |
| 1265810881 | Gregory Ramsay | Counselor | 748 14th Avenue, Longview, WA 98632 | 2015-05-14 |
| 1891040812 | Laura Shellman | Nurse Practitioner | 748 14th Avenue, Longview, WA 98632 | 2012-07-16 |
| 1891074076 | Vincent John Straube | Counselor | 748 14th Avenue, Longview, WA 98632 | 2011-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316589559 | Nicole Wilhoit | Peer Specialist | 1338 Commerce Ave Ste F, Longview, WA 98632-3743 | 2019-10-09 |
| 1508323221 | Teri Lee Owen | Peer Specialist | 1338 Commerce Ave Ste H, Longview, WA 98632-3732 | 2019-02-28 |
| 1184140881 | Kimberly Denise Smith | Peer Specialist | 720 14th Ave Fl 2, Longview, WA 98632-2315 | 2017-08-15 |
| 1598362246 | Jamie Lucas | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-10-06 |
| 1104439587 | Heather Marie Kraft | Peer Specialist | 900 Fir St, Longview, WA 98632-2544 | 2020-08-26 |
| 1528676632 | Trenda Deann Hope | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-07-15 |
| 1932717030 | Rachael Taylor | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-07-15 |
| 1366050379 | Guy Steele | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-07-15 |
| 1073147880 | Kaylee Moe | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-03-02 |
| 1952935827 | April Rupp | Peer Specialist | 748 14th Ave, Longview, WA 98632-2315 | 2020-02-28 |
| Find all providers in LONGVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.