MEDICARE: MRS. LAUREL FRANCES TRAVIS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114255726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREL FRANCES TRAVIS

Provider Business Mailing Address
First Line	:	3664 WILSON WAY
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4915
Country	:	US
Telephone Number	:	307-371-6719
Fax Number	:	307-362-4615

Provider Business Practice Location Address
First Line	:	3664 WILSON WAY
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4915
Country	:	US
Telephone Number	:	307-371-6719
Fax Number	:	307-362-4615

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

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	11/20/2009

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