Provider Demographics
NPI:1093339194
Name:LITTLE WIND CONVENIENT CARE
Entity Type:Organization
Organization Name:LITTLE WIND CONVENIENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-701-1698
Mailing Address - Street 1:704 E FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4421
Mailing Address - Country:US
Mailing Address - Phone:573-701-1698
Mailing Address - Fax:
Practice Address - Street 1:704 E FREMONT AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4421
Practice Address - Country:US
Practice Address - Phone:573-701-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care