Healthcare Provider Details

I. General information

NPI: 1932433943
Provider Name (Legal Business Name): CHARLYN BLUEMEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MT. VIEW DR.
LYMAN WY
82937-0908
US

IV. Provider business mailing address

1500 MT. VIEW DR.
LYMAN WY
82937-0908
US

V. Phone/Fax

Practice location:
  • Phone: 307-786-4556
  • Fax:
Mailing address:
  • Phone: 307-786-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: