Healthcare Provider Details

I. General information

NPI: 1225209406
Provider Name (Legal Business Name): CHERYL LYNN LAMB-GROVES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BLACK COAL ROAD
FT. WASHAKIE WY
82514
US

IV. Provider business mailing address

1627 SINKS CANYON RD
LANDER WY
82520-9716
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-7300
  • Fax:
Mailing address:
  • Phone: 307-335-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number21178
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: