Healthcare Provider Details

I. General information

NPI: 1073985883
Provider Name (Legal Business Name): SADIE ANN WEST MS PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DEWAR DR
ROCK SPRINGS WY
82901-6218
US

IV. Provider business mailing address

4000 DEWAR DR
ROCK SPRINGS WY
82901-6218
US

V. Phone/Fax

Practice location:
  • Phone: 307-382-3010
  • Fax: 307-382-6881
Mailing address:
  • Phone: 307-382-3010
  • Fax: 307-382-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC-906
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: