Healthcare Provider Details

I. General information

NPI: 1437314572
Provider Name (Legal Business Name): BETH J KAMBER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N 30TH ST
LARAMIE WY
82072-5140
US

IV. Provider business mailing address

255 N 30TH ST
LARAMIE WY
82072-5140
US

V. Phone/Fax

Practice location:
  • Phone: 307-742-2142
  • Fax: 307-745-5830
Mailing address:
  • Phone: 307-742-2142
  • Fax: 307-745-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number530964
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: