Healthcare Provider Details

I. General information

NPI: 1922242353
Provider Name (Legal Business Name): WELLNESS SCREENING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 E 1ST ST SUITE A
CASPER WY
82601-2747
US

IV. Provider business mailing address

1988 E 1ST ST SUITE A
CASPER WY
82601-2747
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-6004
  • Fax: 307-235-6009
Mailing address:
  • Phone: 307-235-6004
  • Fax: 307-235-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALERIE ROBERTS
Title or Position: OWNER MT ASCP
Credential:
Phone: 307-235-6004