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General NPI Number Information
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NPI Number | 1730636812
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Entity Type | Organization
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Legal Business Name | CROSSROADS HEALTH LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 1842 SUGARLAND DR SUITE 103
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City | SHERIDAN
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State | WY
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Zip | 82801-5775
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Country | US
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Telephone | 307-751-0645
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7221
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City | SHERIDAN
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State | WY
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Zip | 82801-7004
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Country | US
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Telephone | 307-751-0645
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. WENDY JO WOOD NEESON
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Credential | FNP
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Telephone | 307-751-0645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 19472.0369
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License Number State | WY
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