Healthcare Provider Details

I. General information

NPI: 1962333286
Provider Name (Legal Business Name): PATRICIA ANN CHIVERS MC PCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E 4TH ST
GILLETTE WY
82716-4033
US

IV. Provider business mailing address

812 E 4TH ST
GILLETTE WY
82716-4033
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-1204
  • Fax:
Mailing address:
  • Phone: 307-682-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1633
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: