MEDICARE: SISTERHOOD SANCTUARY LLC

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner

General Provider Information

NPI Number	:	1790649168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISTERHOOD SANCTUARY LLC

Provider Business Mailing Address
First Line	:	48 LANDON LN
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-9014
Country	:	US
Telephone Number	:	307-752-5078
Fax Number	:

Provider Business Practice Location Address
First Line	:	1842 SUGARLAND DR STE 101
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5719
Country	:	US
Telephone Number	:	307-763-8701
Fax Number	:	307-224-2239

Authorized Official
Title or Position	:	MA
Name	:	ASHTON MCCOMB
Credential	:
Telephone Number	:	307-752-5078

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

Similar Medicare Providers

1598629024 — TANYON KELLER
Practice Location Address:

1842 SUGARLAND DR STE 101 , 101
SHERIDAN, WY
82801-5719

Practice Phone: 307-763-8701
Practice Fax:

1093679201 — ELIZABETH JEAN MOORE
Practice Location Address:

1842 SUGARLAND DR STE 101
SHERIDAN, WY
82801-5719

Practice Phone: 307-763-8701
Practice Fax:

1063417954 — DR. SUSAN K. ROBERTS M.D.
Practice Location Address:

1842 SUGARLAND DR , SUITE 101
SHERIDAN, WY
82801-5719

Practice Phone: 307-673-4960
Practice Fax: 307-673-4951

1568418192 — SOUTH SHERIDAN MEDICAL CENTER, INC
Practice Location Address:

1842 SUGARLAND DRIVE , SUITE 103
SHERIDAN, WY
82801-5719

Practice Phone: 307-673-4960
Practice Fax: 307-673-4951

1477061836 — LEESA MARIE BELUS AGACNP-BC
Practice Location Address:

1842 SUGARLAND DR STE 103
SHERIDAN, WY
82801-5719

Practice Phone: 307-673-4960
Practice Fax: 307-673-4951

1942376454 — ALTERNATIVE MEDICINE OF TULSA INC
Practice Location Address:

4845 S SHERIDAN RD STE 509
TULSA, OK
74145-5719

Practice Phone: 918-660-0031
Practice Fax: 918-660-0056

Directions to “SISTERHOOD SANCTUARY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.