Provider Demographics
NPI:1508168642
Name:LEIGHT, IVY S (MS)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:S
Last Name:LEIGHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VIVIGEN WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5600
Mailing Address - Country:US
Mailing Address - Phone:800-848-4436
Mailing Address - Fax:505-438-2269
Practice Address - Street 1:2000 VIVIGEN WAY
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5600
Practice Address - Country:US
Practice Address - Phone:800-848-4436
Practice Address - Fax:505-438-2269
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS