MEDICARE: SALLY RAFERT FNP-C

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	363LF0000X	Family Nurse Practitioner	55013	WY

General Provider Information

NPI Number	:	1053098749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY RAFERT FNP-C

Provider Business Mailing Address
First Line	:	5807 BASTION RD
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-8236
Country	:	US
Telephone Number	:	307-745-0085
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 MCCOLLUM ST STE 104
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5151
Country	:	US
Telephone Number	:	307-745-0085
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	04/11/2026

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Directions to “ SALLY RAFERT FNP-C” Practice Location

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