Individual
JULIANNE ALICE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
167 NORTH MAIN STREET, TUBA CITY, AZ 86045
(928) 283-2679
Mailing address
PO BOX 600, TUBA CITY, AZ 86045-0600
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2019018901
MO
Other
Enumeration date
06/17/2019
Last updated
09/27/2022
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