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General NPI Number Information
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NPI Number | 1215228804
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WYOMING
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Dates
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Enumeration Date | 04/29/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 1000 E UNIVERSITY AVE
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City | LARAMIE
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State | WY
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Zip | 82071-2000
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Country | US
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Telephone | 307-766-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 E UNIVERSITY AVE
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City | LARAMIE
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State | WY
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Zip | 82071-2000
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HEAD ATHLETIC TRAINER
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Name | BOB WALLER
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Credential | ATC
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Telephone | 307-766-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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