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General NPI Number Information
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NPI Number | 1053877654
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Entity Type | Organization
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Legal Business Name | INSTACARE CENTER OF WYOMING - WEST, INC
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Dates
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Enumeration Date | 02/19/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 900 CY AVE
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City | CASPER
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State | WY
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Zip | 82601-4174
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Country | US
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Telephone | 307-266-1719
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Fax | 307-472-7150
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Provider Business Mailing Address
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Address Line | 900 CY AVE
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City | CASPER
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State | WY
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Zip | 82601-4174
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Country | US
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Telephone | 307-266-1719
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Fax | 307-472-7150
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Authorized Official
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Title or Position | DIRECTOR
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Name | NICOLETTE HANSON
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Credential | DNP, FNP-BC
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Telephone | 307-266-1719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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