Healthcare Provider Details

I. General information

NPI: 1255438651
Provider Name (Legal Business Name): COUNTY OF CONVERSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N RUSSELL AVE
DOUGLAS WY
82633-2315
US

IV. Provider business mailing address

255 N RUSSELL AVE
DOUGLAS WY
82633-2315
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-2536
  • Fax: 307-358-3941
Mailing address:
  • Phone: 307-358-2536
  • Fax: 307-358-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDREA RENEE HISER
Title or Position: OFFICE MANAGER
Credential:
Phone: 307-358-2536