Healthcare Provider Details

I. General information

NPI: 1023479581
Provider Name (Legal Business Name): MRS. AUBRI M VAHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MONTALTO DR UNIT D
CHEYENNE WY
82007-6514
US

IV. Provider business mailing address

110 MONTALTO DR UNIT D
CHEYENNE WY
82007-6514
US

V. Phone/Fax

Practice location:
  • Phone: 307-287-6110
  • Fax:
Mailing address:
  • Phone: 307-287-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number108824624
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: