| NPI | 1710530837 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY ANDERSON Billing 307-212-6242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208VP0000X Pain Medicine, Pain Medicine | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2022-04-22 |