Healthcare Provider Details

I. General information

NPI: 1902172562
Provider Name (Legal Business Name): LUCINDA MARIE ATNIP RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCINDA MARIE WILSON RDN

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5642 GREYBULL HWY
CODY WY
82414-9618
US

IV. Provider business mailing address

5642 GREYBULL HWY
CODY WY
82414-9618
US

V. Phone/Fax

Practice location:
  • Phone: 307-250-4966
  • Fax: 918-585-3047
Mailing address:
  • Phone: 307-250-4966
  • Fax: 918-585-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number289
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1798
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: