| NPI | 1386303915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN PETERSEN Payer Enrollment Specialist 307-432-3664 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2025-09-04 |