Healthcare Provider Details

I. General information

NPI: 1508787292
Provider Name (Legal Business Name): CHRISTINE E SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR STE 104
ROCK SPRINGS WY
82901-5858
US

IV. Provider business mailing address

PO BOX 248
GREEN RIVER WY
82935-0248
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-6082
  • Fax:
Mailing address:
  • Phone: 307-212-6082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number40231
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: