Provider Demographics
NPI:1437663143
Name:BAUMGARTNER, MELANIE JOY
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JOY
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2342
Mailing Address - Country:US
Mailing Address - Phone:307-703-0216
Mailing Address - Fax:
Practice Address - Street 1:1158 N 19TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2342
Practice Address - Country:US
Practice Address - Phone:130-776-0296
Practice Address - Fax:307-760-2967
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator