Provider Demographics
NPI:1376252999
Name:MONOGRAM HEALTH PROFESSIONAL SERVICES OF WYOMING LLC
Entity Type:Organization
Organization Name:MONOGRAM HEALTH PROFESSIONAL SERVICES OF WYOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-994-1889
Mailing Address - Street 1:5410 MARYLAND WAY STE 301
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-673-4455
Mailing Address - Fax:
Practice Address - Street 1:1603 CAPITOL AVE STE 403
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4562
Practice Address - Country:US
Practice Address - Phone:615-673-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty