Provider Demographics
NPI:1629305461
Name:HUMMON, IVY NICOLE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:NICOLE
Last Name:HUMMON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8413 PLACIDA RD UNIT 304
Mailing Address - Street 2:
Mailing Address - City:CAPE HAZE
Mailing Address - State:FL
Mailing Address - Zip Code:33946-2462
Mailing Address - Country:US
Mailing Address - Phone:413-519-2568
Mailing Address - Fax:
Practice Address - Street 1:8413 PLACIDA RD UNIT 304
Practice Address - Street 2:
Practice Address - City:CAPE HAZE
Practice Address - State:FL
Practice Address - Zip Code:33946-2462
Practice Address - Country:US
Practice Address - Phone:413-519-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 232175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay