| NPI | 1235282120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY J FARRIS Fnp 307-432-0335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WY 159020190) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-06-23 |