| NPI | 1124188545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANNE MALODY Owner 307-682-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 5806A) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: WY 5853A) |
| 363LF0000X Nurse Practitioner Family (Licence: WY 18882.269) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-08-22 |