Provider Demographics
NPI:1104176643
Name:DUMMAR, ELIZABETH MARLOWE
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARLOWE
Last Name:DUMMAR
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 1:1600 JOHN ADAMS PKWY
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4300
Mailing Address - Country:US
Mailing Address - Phone:208-529-5276
Mailing Address - Fax:208-529-6506
Practice Address - Street 1:1600 JOHN ADAMS PKWY
Practice Address - Street 2:SUITE # 102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4300
Practice Address - Country:US
Practice Address - Phone:208-529-5276
Practice Address - Fax:208-529-6506
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker