Provider Demographics
NPI:1518206630
Name:BRUCE LYMAN
Entity Type:Organization
Organization Name:BRUCE LYMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPITE CARE AIDE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-250-5386
Mailing Address - Street 1:15 SCHNEIDER RD
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9232
Mailing Address - Country:US
Mailing Address - Phone:307-250-5386
Mailing Address - Fax:
Practice Address - Street 1:15 SCHNEIDER RD
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9232
Practice Address - Country:US
Practice Address - Phone:307-250-5386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty