Healthcare Provider Details

I. General information

NPI: 1215953385
Provider Name (Legal Business Name): AMY M. RABON CNM,M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S GOULD ST
SHERIDAN WY
82801-6321
US

IV. Provider business mailing address

PO BOX 5087
SHERIDAN WY
82801-1387
US

V. Phone/Fax

Practice location:
  • Phone: 307-763-8701
  • Fax: 307-224-2293
Mailing address:
  • Phone: 307-763-8701
  • Fax: 307-224-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number22464.343
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: