Provider Demographics
NPI:1538236948
Name:BELL-MILBY, SUSAN A (CNS, BC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:BELL-MILBY
Suffix:
Gender:F
Credentials:CNS, BC
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:A
Other - Last Name:BELL-MILBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN
Mailing Address - Street 1:PO BOX 1656
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0198
Mailing Address - Country:US
Mailing Address - Phone:307-463-0945
Mailing Address - Fax:307-463-0946
Practice Address - Street 1:103N 5TH E ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4402
Practice Address - Country:US
Practice Address - Phone:307-463-0945
Practice Address - Fax:307-463-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY18976.0202364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY18976.0202OtherSTATE LICENSE
WY1205005 00Medicaid
WY1205005 00Medicaid
WY1205005 00Medicaid
WYW24000Medicare PIN