Healthcare Provider Details

I. General information

NPI: 1972377059
Provider Name (Legal Business Name): EMILY ANNE WIMSATT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS EMILY ANNE SCHOCK

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 CEDAR AVE
SHERIDAN WY
82801-5434
US

IV. Provider business mailing address

1563 CEDAR AVE
SHERIDAN WY
82801-5434
US

V. Phone/Fax

Practice location:
  • Phone: 605-377-7327
  • Fax:
Mailing address:
  • Phone: 605-377-7327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number51124
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number51124
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number51124
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number51124
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: