Healthcare Provider Details

I. General information

NPI: 1740762426
Provider Name (Legal Business Name): SANDRA RENEE HOPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA RENEE DAVIS FNP-C

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E 2ND ST
CASPER WY
82609-2052
US

IV. Provider business mailing address

5000 BLACKMORE RD
CASPER WY
82609-3345
US

V. Phone/Fax

Practice location:
  • Phone: 307-309-5915
  • Fax: 307-372-9959
Mailing address:
  • Phone: 307-233-6000
  • Fax: 307-236-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number14-116206-111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number2005040254
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018036806
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number48934
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: