Healthcare Provider Details

I. General information

NPI: 1508152786
Provider Name (Legal Business Name): STEPHANIE CHIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2011
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W SPRUCE ST UNIT A
RAWLINS WY
82301-5371
US

IV. Provider business mailing address

PO BOX 1687
RAWLINS WY
82301-1687
US

V. Phone/Fax

Practice location:
  • Phone: 307-328-5595
  • Fax: 307-328-5561
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0051537
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4056
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51537
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11866C
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: