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General NPI Number Information
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NPI Number | 1538784251
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Entity Type | Individual
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Provider Name | IVY DAEP
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 770 TAMALPAIS DR STE 410
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City | CORTE MADERA
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State | CA
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Zip | 94925-1739
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Country | US
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Telephone | 154-925-1822
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 COTTONTAIL LN
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City | SOMERSET
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State | NJ
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Zip | 08873-5125
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Country | US
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Telephone |
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Fax |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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