Provider Demographics
NPI:1033211776
Name:RIPLEY, IDA (CNM)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5161 S COTTONWOOD ST
Mailing Address - Street 2:STE 130
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157
Mailing Address - Country:US
Mailing Address - Phone:801-507-7070
Mailing Address - Fax:801-507-7089
Practice Address - Street 1:5161 S COTTONWOOD ST
Practice Address - Street 2:STE 130
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-7070
Practice Address - Fax:801-507-7089
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2121704402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005818301Medicare PIN
UT0069960123Medicare PIN