Healthcare Provider Details

I. General information

NPI: 1174356265
Provider Name (Legal Business Name): SARAH RENNEISEN-SCHMIDT MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD BLDG 7
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

9017 BLUE MESA RD
CHEYENNE WY
82009-8403
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7550
  • Fax:
Mailing address:
  • Phone: 307-631-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number32287
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: