Healthcare Provider Details

I. General information

NPI: 1578773537
Provider Name (Legal Business Name): WANDA M. FRANK P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

IV. Provider business mailing address

5050 POWDERHOUSE RD
CHEYENNE WY
82009-4800
US

V. Phone/Fax

Practice location:
  • Phone: 307-772-8226
  • Fax: 307-634-1271
Mailing address:
  • Phone: 307-772-8226
  • Fax: 307-634-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPENDING
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: