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General NPI Number Information
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NPI Number | 1912051152
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Entity Type | Organization
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Legal Business Name | WESTERN NURSING
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 911 EDWARDS ST
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City | GILLETTE
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State | WY
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Zip | 82718-6403
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Country | US
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Telephone | 307-687-7757
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Fax | 307-685-1284
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Provider Business Mailing Address
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Address Line | 911 EDWARDS ST
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City | GILLETTE
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State | WY
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Zip | 82718-6403
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Country | US
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Telephone | 307-687-7757
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Fax | 307-685-1284
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT PAUL LOWE
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Credential |
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Telephone | 307-687-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 251C00000X
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License Number State | WY
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