Healthcare Provider Details

I. General information

NPI: 1962749572
Provider Name (Legal Business Name): COURTNIE STRINGHAM RT (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLACK COAL RD BLDG 29
FORT WASHAKIE WY
82514-0128
US

IV. Provider business mailing address

1003 N 16TH ST E
RIVERTON WY
82501-3025
US

V. Phone/Fax

Practice location:
  • Phone: 307-855-2971
  • Fax: 307-857-2898
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number425565
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: