Healthcare Provider Details

I. General information

NPI: 1639902976
Provider Name (Legal Business Name): CHRISTY WILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

2306 EAST PERSHING BLVD
CHEYENNE WY
82001
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7550
  • Fax: 307-778-7328
Mailing address:
  • Phone: 307-778-7550
  • Fax: 307-778-7328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21734
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: