| NPI | 1962804443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA S JUAREZ Office Manager 307-789-8721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WY 22692.1338) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |