Provider Demographics
NPI:1649966276
Name:WELCH, IVY DEAN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:DEAN
Last Name:WELCH
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12493 S SHADE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1678
Mailing Address - Country:US
Mailing Address - Phone:801-362-8804
Mailing Address - Fax:
Practice Address - Street 1:1320 W SOUTH JORDAN PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8847
Practice Address - Country:US
Practice Address - Phone:801-254-9700
Practice Address - Fax:801-254-9755
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11612851-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily