| NPI | 1942664107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA WILSON Practice Manager 307-682-6263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WY 7203A) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 8045A) |
| 207V00000X Obstetrics & Gynecology (Licence: WY 8335A) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2024-03-15 |