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General NPI Number Information
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NPI Number | 1790649168
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Entity Type | Organization
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Legal Business Name | SISTERHOOD SANCTUARY LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1842 SUGARLAND DR STE 101
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City | SHERIDAN
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State | WY
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Zip | 82801-5719
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Country | US
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Telephone | 307-763-8701
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Fax | 307-224-2239
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Provider Business Mailing Address
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Address Line | 48 LANDON LN
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City | SHERIDAN
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State | WY
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Zip | 82801-9014
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Country | US
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Telephone | 307-752-5078
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Fax |
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Authorized Official
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Title or Position | MA
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Name | ASHTON MCCOMB
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Credential |
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Telephone | 307-752-5078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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