Individual
IVY MARIE VACHON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 W FAIR AVE, SUITE 36, MARQUETTE, MI 49855-2675
(906) 225-3867
Mailing address
PO BOX 1866, GREEN BAY, WI 54305-1866
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
67308-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
4301105908
MI
Other
Enumeration date
06/20/2014
Last updated
07/21/2022
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