Individual
IVY A. HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
2065 E 17TH ST, SUITE D, IDAHO FALLS, ID 83404-8042
(208) 522-0747
(208) 522-9641
Mailing address
2065 E 17TH ST, SUITE D, IDAHO FALLS, ID 83404-8042
(208) 522-0747
(208) 522-9641
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-814
ID
Other
Enumeration date
09/09/2009
Last updated
09/09/2009
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