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General NPI Number Information
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NPI Number | 1417722851
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Entity Type | Individual
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Provider Name | IVY ALLEN CPM, LM
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Gender | Female
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 378 S RIDGE AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83402-4115
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Country | US
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Telephone | 608-863-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 3818 E 196 N
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City | RIGBY
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State | ID
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Zip | 83442-5670
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Country | US
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Telephone | 608-863-1099
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Fax | 208-745-5052
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175M00000X
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Taxonomy Name | Lay Midwife
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License Number | MID-154
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MID-154
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License Number State | ID
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