Ivy Lane Pediatrics, LLC
NPI #1083635692 in South Ogden, Utah
Provider Information
- NPI Number
- 1083635692
- Entity Type
- Organization
- Organization Name
- Ivy Lane Pediatrics, LLC
- Primary Specialty
- Home Health
- Enumeration Date
- Jul 21, 2006
- Last Updated
- Jan 21, 2022
Practice Location
- Address
- 5974 FASHION POINT DR STE 230
- City
- South Ogden
- State
- Utah
- ZIP Code
- 84403-4805
- Phone
- (801) 774-9698
Authorized Official
- Name
- WYNDAM REEVE, MD
- Title
- ADMINISTRATOR
- Phone
- (801) 774-9698
Specialties & Taxonomy Codes
| Specialty |
|---|
| Home Health |
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