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General NPI Number Information
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NPI Number | 1992744817
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Entity Type | Organization
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Legal Business Name | WIND RIVER OBSTETRICS AND GYNECOLOGY LLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 1005 COLLEGE VIEW DR
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City | RIVERTON
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State | WY
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Zip | 82501-2266
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Country | US
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Telephone | 307-857-5217
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Fax | 307-857-5215
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Provider Business Mailing Address
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Address Line | 1005 COLLEGE VIEW DR
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City | RIVERTON
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State | WY
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Zip | 82501-2289
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Country | US
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Telephone | 307-856-4232
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Fax | 307-856-4243
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Authorized Official
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Title or Position | CEO
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Name | MARYANNE A HANNANEY
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Credential | MD
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Telephone | 307-857-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 6798A
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License Number State | WY
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