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1164755104
IVY A. HANSEN
IDAHO FALLS, ID
NPI
1164755104
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: ID PA-814)
Enumeration Date
2009-09-09
Last Update Date
2009-09-09
Business Address
-- IVY A. HANSEN P.A.-C.
2065 E 17TH ST SUITE D
IDAHO FALLS, ID 83404-8042
Phone number: 208-522-0747
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Mailing Address
-- IVY A. HANSEN P.A.-C.
2065 E 17TH ST SUITE D
IDAHO FALLS, ID 83404-8042
Phone number: 208-522-0747
Copy
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