Healthcare Provider Details

I. General information

NPI: 1881995264
Provider Name (Legal Business Name): CAITLIN PATRICIA VASQUEZ P.M.H.N.P.-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1277 N 15TH ST
LARAMIE WY
82072-2343
US

IV. Provider business mailing address

1277 N 15TH ST
LARAMIE WY
82072-2343
US

V. Phone/Fax

Practice location:
  • Phone: 307-742-2266
  • Fax: 307-742-9905
Mailing address:
  • Phone: 307-742-2266
  • Fax: 307-742-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number18677-1084
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: