Provider Demographics
NPI:1326206616
Name:WIND RIVER SERVICE UNIT IHS
Entity Type:Organization
Organization Name:WIND RIVER SERVICE UNIT IHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:RENE'
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-332-7300
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0128
Mailing Address - Country:US
Mailing Address - Phone:307-332-7300
Mailing Address - Fax:307-332-9446
Practice Address - Street 1:29 BLACK COAL DR
Practice Address - Street 2:
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514-0000
Practice Address - Country:US
Practice Address - Phone:307-332-7300
Practice Address - Fax:307-332-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9336261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service