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Organization
IVY LANE PEDIATRICS, LLC
Active
Organization
IVY LANE PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WYNDAM REEVE MD (ADMINISTRATOR)
(801) 774-9698
Entity
Organization
Contact information
Practice address
5974 FASHION POINT DR STE 230, SOUTH OGDEN, UT 84403-4805
(801) 774-9698
(801) 728-0641
Mailing address
5974 FASHION POINT DR STE 230, SOUTH OGDEN, UT 84403-4805
(801) 774-9698
(801) 728-0641
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
07/21/2006
Last updated
01/21/2022
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