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
1	171M00000X	Case 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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