MEDICARE: MRS. SUSAN KAY KOLLMANN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	22036	WY

General Provider Information

NPI Number	:	1003960600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN KAY KOLLMANN RN

Provider Business Mailing Address
First Line	:	1020 SAINT MARY ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1227
Country	:	US
Telephone Number	:	307-234-1104
Fax Number	:	307-234-1104

Provider Business Practice Location Address
First Line	:	1020 SAINT MARY ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1227
Country	:	US
Telephone Number	:	307-234-1104
Fax Number	:	307-234-1104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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