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General NPI Number Information
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NPI Number | 1376019000
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Entity Type | Organization
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Legal Business Name | COTTONWOOD HEALTHCARE, INC.
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Dates
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Enumeration Date | 10/20/2018
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Last Update Date | 10/20/2018
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Provider Practice Location Address
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Address Line | 304 COFFEEN AVE STE B
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City | SHERIDAN
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State | WY
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Zip | 82801-4803
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Country | US
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Telephone | 307-763-4071
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Fax | 307-763-4109
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Provider Business Mailing Address
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Address Line | 1829 MEADOWLARK LN
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City | SHERIDAN
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State | WY
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Zip | 82801-4503
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Country | US
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Telephone | 307-217-3257
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Fax | 307-763-4109
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Authorized Official
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Title or Position | OWNER
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Name | MARLENE ANN SCHUMAN
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Credential | FNP-BC
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Telephone | 307-217-3257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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