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General NPI Number Information
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NPI Number | 1366719718
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Entity Type | Organization
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Legal Business Name | BIDONDE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 107 W HESSE ST
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City | BUFFALO
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State | WY
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Zip | 82834-1501
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Country | US
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Telephone | 307-684-1444
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Fax | 307-684-0999
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Provider Business Mailing Address
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Address Line | 107 W HESSE ST
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City | BUFFALO
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State | WY
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Zip | 82834-1501
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Country | US
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Telephone | 307-684-1444
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Fax | 307-684-0999
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Authorized Official
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Title or Position | NURSE PRACTITIONER OWNER
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Name | MS. SANDRA K HAM
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Credential | FNP-C
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Telephone | 307-684-1444
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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 | 23899-0963
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License Number State | WY
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