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General NPI Number Information
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NPI Number | 1477265544
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Entity Type | Organization
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Legal Business Name | UNTO L.L.C.
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 395 HARVEY LN
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City | SHERIDAN
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State | WY
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Zip | 82801-9129
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Country | US
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Telephone | 307-680-3761
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Fax | 307-429-5654
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Provider Business Mailing Address
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Address Line | 1590 SUGARLAND DR # 161
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City | SHERIDAN
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State | WY
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Zip | 82801-5776
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Country | US
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Telephone | 307-752-0221
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MICHELLE RENEE PARKER
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Credential | APRN-FNP-BC
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Telephone | 307-680-3761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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