Individual
EVAN DAYNE IVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3456 E 17TH ST STE 190, AMMON, ID 83406-6749
(208) 524-2222
(855) 999-9242
Mailing address
3456 E 17TH ST STE 190, AMMON, ID 83406-6749
(208) 524-2222
(855) 999-9242
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1265
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174919534
—
ID
05
—
473675862
—
ID
Enumeration date
10/15/2014
Last updated
09/03/2025
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