Healthcare Provider Details

I. General information

NPI: 1851410682
Provider Name (Legal Business Name): LARAMIE REPRODUCTIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 N 22ND ST SUITE A
LARAMIE WY
82072
US

IV. Provider business mailing address

1252 N 22ND ST SUITE A
LARAMIE WY
82072
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-5364
  • Fax: 307-745-4164
Mailing address:
  • Phone: 307-745-5364
  • Fax: 307-745-4164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateWY

VIII. Authorized Official

Name: MATTHEW MILLER
Title or Position: EXEC DIRECTOR
Credential:
Phone: 307-745-4364