Healthcare Provider Details

I. General information

NPI: 1548484827
Provider Name (Legal Business Name): DAVID ARLAND POMERINKE PCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 CITY VIEW DR #302
EVANSTON WY
82930-5307
US

IV. Provider business mailing address

350 CITY VIEW DR #302
EVANSTON WY
82930-5327
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-7915
  • Fax: 307-789-6009
Mailing address:
  • Phone: 307-789-7915
  • Fax: 307-789-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPCSW-270
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: