Provider Demographics
NPI:1407285190
Name:FANCHER, TORI
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:FANCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:LEE
Other - Last Name:CRYANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4259
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4259
Mailing Address - Country:US
Mailing Address - Phone:307-733-7637
Mailing Address - Fax:307-733-7675
Practice Address - Street 1:20 PIONEER LN
Practice Address - Street 2:SUITE 201
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8177
Practice Address - Country:US
Practice Address - Phone:307-733-7637
Practice Address - Fax:307-733-7675
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator