Provider Demographics
NPI:1477817583
Name:BANCROFT, KRISTEN DEWAR
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:DEWAR
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:BANCROFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2538 BIG HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9299
Mailing Address - Country:US
Mailing Address - Phone:307-587-2197
Mailing Address - Fax:307-527-6218
Practice Address - Street 1:2713 COUGAR AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8400
Practice Address - Country:US
Practice Address - Phone:307-587-5112
Practice Address - Fax:307-587-5446
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker