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General NPI Number Information
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NPI Number | 1770681439
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WYOMING
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 820 E 17TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-4714
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Country | US
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Telephone | 307-632-2434
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Fax | 307-638-3616
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Provider Business Mailing Address
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Address Line | 820 E 17TH ST
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City | CHEYENNE
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State | WY
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Zip | 82001-4714
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Country | US
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Telephone | 307-632-2434
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Fax | 307-638-3616
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Authorized Official
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Title or Position | CREDENTIALING SPECIALISTS
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Name | PAMELA ADAMS
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Credential |
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Telephone | 307-766-3044
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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 | WY
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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