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General NPI Number Information
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NPI Number | 1912047564
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Entity Type | Individual
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Provider Name | SHERRIE DAWN RUBIO-WALLACE FNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 1252 N 22ND ST UNIT A
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City | LARAMIE
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State | WY
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Zip | 82072-5306
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Country | US
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Telephone | 307-745-5364
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Fax | 307-745-4164
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Provider Business Mailing Address
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Address Line | 2161 N 17TH ST
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City | LARAMIE
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State | WY
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Zip | 82072-1912
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Country | US
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Telephone | 307-742-4054
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Fax | 307-766-4294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 18783.0221
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License Number State | WY
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