MEDICARE: DESERIEE STOFFERAHN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	49265	WY
2	363LG0600X	Gerontology Nurse Practitioner	49265	WY

General Provider Information

NPI Number	:	1457003139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESERIEE STOFFERAHN

Provider Business Mailing Address
First Line	:	3000 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4202
Country	:	US
Telephone Number	:	307-212-7708
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4202
Country	:	US
Telephone Number	:	307-212-7708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	06/10/2026

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Directions to “ DESERIEE STOFFERAHN ” Practice Location

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