Healthcare Provider Details

I. General information

NPI: 1205267655
Provider Name (Legal Business Name): CHELSEA CHANTELLE MOWER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 E 2ND ST SUITE 200
CASPER WY
82609-2062
US

IV. Provider business mailing address

2546 E 2ND ST SUITE 200
CASPER WY
82609-2062
US

V. Phone/Fax

Practice location:
  • Phone: 307-265-1110
  • Fax:
Mailing address:
  • Phone: 307-265-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29512.1291
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: