Healthcare Provider Details

I. General information

NPI: 1659365633
Provider Name (Legal Business Name): JANET K LAIDLAW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 HOUSE AVE SUITE 201
CHEYENNE WY
82001-3176
US

IV. Provider business mailing address

2301 HOUSE AVE SUITE 201
CHEYENNE WY
82001-3176
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-9131
  • Fax: 307-637-8300
Mailing address:
  • Phone: 307-635-9131
  • Fax: 307-637-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13382194
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: