Healthcare Provider Details

I. General information

NPI: 1023346822
Provider Name (Legal Business Name): ALYCE PETERS CMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 FAIRVIEW DR
RIVERTON WY
82501-3217
US

IV. Provider business mailing address

1105 FAIRVIEW DR
RIVERTON WY
82501-3217
US

V. Phone/Fax

Practice location:
  • Phone: 307-857-1295
  • Fax:
Mailing address:
  • Phone: 307-857-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ALYCE J PETERS
Title or Position: OWNER
Credential:
Phone: 307-857-1295