Healthcare Provider Details

I. General information

NPI: 1598246894
Provider Name (Legal Business Name): MICHELE DAWN FLYR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 OVERTHRUST RD
EVANSTON WY
82930
US

IV. Provider business mailing address

PO BOX 2910
EVANSTON WY
82931-2910
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-4224
  • Fax: 307-789-4225
Mailing address:
  • Phone: 307-789-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: