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General NPI Number Information
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NPI Number | 1740120583
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Entity Type | Organization
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Legal Business Name | WOUND CARE OF IDAHO LLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 1129 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2903
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Country | US
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Telephone | 307-296-9399
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Fax | 307-333-0299
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Provider Business Mailing Address
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Address Line | 1129 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2903
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Country | US
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Telephone | 307-296-9399
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Fax | 307-333-0299
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINA LAIRD-ROGERS
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Credential | FNP-C
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Telephone | 307-259-9269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SC2300X
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Taxonomy Name | Chronic Care Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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