Provider Demographics
NPI:1093437881
Name:SCHWABEROW, IVORY MELIKA
Entity Type:Individual
Prefix:
First Name:IVORY
Middle Name:MELIKA
Last Name:SCHWABEROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3372
Mailing Address - Country:US
Mailing Address - Phone:303-880-2808
Mailing Address - Fax:
Practice Address - Street 1:3455 WILLOW ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3372
Practice Address - Country:US
Practice Address - Phone:303-880-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA334970174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN