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NPI Code Detail

MEDICARE: MS. MAURICA RAE MEDDERS

MEDICARE:  MS. MAURICA RAE MEDDERS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1659616308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MAURICA RAE MEDDERS
Provider Business Mailing Address
First Line : PO BOX 393
Second Line :
City : CASPER
State : WY
Zip : 82602-0393
Country : US
Telephone Number : 307-577-4913
Fax Number : 307-577-4014
Provider Business Practice Location Address
First Line : 355 N LINCOLN ST
Second Line :
City : CASPER
State : WY
Zip : 82601-2037
Country : US
Telephone Number : 307-577-4913
Fax Number : 307-577-4014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2012
Last Update Date : 11/20/2020

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Directions to “ MS. MAURICA RAE MEDDERS ” Practice Location

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