MEDICARE: MRS. ELIZABETH MARLOWE DUMMAR

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1104176643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH MARLOWE DUMMAR

Provider Business Mailing Address
First Line	:	58 E 1ST N
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-1505
Country	:	US
Telephone Number	:	208-709-0434
Fax Number	:	208-269-1550

Provider Business Practice Location Address
First Line	:	58 E 1ST N
Second Line	:
City	:	REXBURG
State	:	ID
Zip	:	83440-1505
Country	:	US
Telephone Number	:	208-709-0434
Fax Number	:	208-269-1550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	09/12/2025

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