Provider Demographics
NPI:1083835359
Name:LEMAGIE, COLLEEN ALISE (APRN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:ALISE
Last Name:LEMAGIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:LEMAGIE
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:SHELL
Mailing Address - State:WY
Mailing Address - Zip Code:82441-0186
Mailing Address - Country:US
Mailing Address - Phone:307-272-8714
Mailing Address - Fax:307-765-2025
Practice Address - Street 1:206 SOUTH SEVENTH STREET
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401
Practice Address - Country:US
Practice Address - Phone:307-272-8714
Practice Address - Fax:307-765-2025
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18397.0176363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner