Provider Demographics
NPI:1073579082
Name:ENLOW, ANN COONROD (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:COONROD
Last Name:ENLOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANNA
Other - Last Name:ENLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:203 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2621
Mailing Address - Country:US
Mailing Address - Phone:307-638-0953
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7555
Practice Address - Fax:307-778-7559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9040-0220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily