Healthcare Provider Details

I. General information

NPI: 1770636276
Provider Name (Legal Business Name): COUNTY OF NIOBRARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S MAIN ST
LUSK WY
82225-5094
US

IV. Provider business mailing address

PO BOX 998
LUSK WY
82225-0998
US

V. Phone/Fax

Practice location:
  • Phone: 307-334-4032
  • Fax:
Mailing address:
  • Phone: 307-334-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELANIE PEARCE
Title or Position: COUNTY NURSE MANAGER
Credential: RN
Phone: 307-286-0220