| NPI | 1124496872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORIA STODDARD President 307-745-8298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 10494.0283) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2015-11-05 |