Healthcare Provider Details

I. General information

NPI: 1740190024
Provider Name (Legal Business Name): MERCEDES NADINE ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MARIPOSA BLVD
CASPER WY
82604-4833
US

IV. Provider business mailing address

1400 MARIPOSA BLVD
CASPER WY
82604-4833
US

V. Phone/Fax

Practice location:
  • Phone: 307-247-5480
  • Fax:
Mailing address:
  • Phone: 307-247-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: