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General NPI Number Information
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NPI Number | 1871623124
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Entity Type | Organization
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Legal Business Name | POPO AGIE WOMEN'S CLINIC, INC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 1460 MAIN ST
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City | LANDER
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State | WY
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Zip | 82520-2657
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Country | US
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Telephone | 307-332-2223
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 MAIN ST
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City | LANDER
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State | WY
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Zip | 82520-2657
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Country | US
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Telephone | 307-332-2223
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. RUTH C ZEBROSKI
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Credential | WHNP-C
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Telephone | 307-332-2223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9192.0137
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 9192.0137
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 9192.0137
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License Number State | WY
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