Healthcare Provider Details

I. General information

NPI: 1114998259
Provider Name (Legal Business Name): NORTHEAST WYOMING PEDIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/10/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 JACKSON AVE
SHERIDAN WY
82801-2708
US

IV. Provider business mailing address

916 JACKSON AVE
SHERIDAN WY
82801-2708
US

V. Phone/Fax

Practice location:
  • Phone: 307-675-5555
  • Fax: 307-675-5599
Mailing address:
  • Phone: 307-675-5555
  • Fax: 307-675-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE OSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-675-5555