Provider Demographics
NPI:1477893253
Name:POMEROY, MINDY RAE (MT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:RAE
Last Name:POMEROY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GREAT PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:ARAPAHO
Mailing Address - State:WY
Mailing Address - Zip Code:82510
Mailing Address - Country:US
Mailing Address - Phone:307-855-2972
Mailing Address - Fax:
Practice Address - Street 1:14 GREAT PLAINS RD.
Practice Address - Street 2:
Practice Address - City:ARAPAHO
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-855-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT227774246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist