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General NPI Number Information
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NPI Number | 1578277604
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Entity Type | Organization
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Legal Business Name | BRIGHT HORIZION PSYCHIATRY
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 855-334-1249
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 855-334-1249
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Fax |
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Authorized Official
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Title or Position | CRNP
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Name | MARJORIE MAINE
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Credential | CRNP
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Telephone | 347-453-1464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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