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NPI Code Detail

MEDICARE: IVORY SOON

MEDICARE: IVORY SOON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist
2171M00000XCase Manager/Care CoordinatorND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922956630
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVORY SOON
Provider Business Mailing Address
First Line : 316 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5218
Country : US
Telephone Number : 701-774-4600
Fax Number : 701-774-4620
Provider Business Practice Location Address
First Line : 316 2ND AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-5218
Country : US
Telephone Number : 701-774-4600
Fax Number : 701-774-4620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/25/2026

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Directions to “ IVORY SOON ” Practice Location

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