Healthcare Provider Details

I. General information

NPI: 1437434354
Provider Name (Legal Business Name): CARVER FAMILY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 ARROWHEAD DR SUITE #4
EVANSTON WY
82930-8752
US

IV. Provider business mailing address

196 ARROWHEAD DR SUITE #4
EVANSTON WY
82930-8752
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-8721
  • Fax: 307-789-8664
Mailing address:
  • Phone: 307-789-8721
  • Fax: 307-789-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21231-1125
License Number StateWY

VIII. Authorized Official

Name: CORRIE R CARVER
Title or Position: NURSE PRACTITIONER
Credential: FNP-BC
Phone: 307-789-8721