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General NPI Number Information
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NPI Number | 1083806111
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Entity Type | Organization
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Legal Business Name | TOTAL FAMILY HEALTH, PC
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 2620 COMMERCIAL WAY SUITE 051
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4755
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Country | US
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Telephone | 307-382-2080
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Fax | 307-382-5099
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Provider Business Mailing Address
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Address Line | 2620 COMMERCIAL WAY SUITE 051
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4755
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Country | US
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Telephone | 307-382-2080
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Fax | 307-382-5099
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA J HEITZ
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Credential | NP
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Telephone | 307-382-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 17189.0261
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License Number State | WY
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