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General NPI Number Information
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NPI Number | 1235282120
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Entity Type | Organization
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Legal Business Name | WYOMING NEUROLOGY P.C.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2301 HOUSE AVE STE 203
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City | CHEYENNE
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State | WY
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Zip | 82001-3176
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Country | US
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Telephone | 307-432-0335
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Fax | 307-432-0341
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Provider Business Mailing Address
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Address Line | 2301 HOUSE AVE STE 203
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City | CHEYENNE
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State | WY
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Zip | 82001-3176
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Country | US
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Telephone | 307-432-0335
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Fax | 307-432-0341
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Authorized Official
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Title or Position | FNP
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Name | TRACY J FARRIS
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Credential | FNP
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Telephone | 307-432-0335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 159020190
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License Number State | WY
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