Provider Demographics
NPI:1548425960
Name:NORTHSTAR SLEEP LAB, LLC
Entity Type:Organization
Organization Name:NORTHSTAR SLEEP LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:VOLNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT/RPSGT
Authorized Official - Phone:307-258-5511
Mailing Address - Street 1:5820 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4308
Mailing Address - Country:US
Mailing Address - Phone:307-265-4626
Mailing Address - Fax:307-265-4680
Practice Address - Street 1:5820 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4308
Practice Address - Country:US
Practice Address - Phone:307-265-4626
Practice Address - Fax:307-265-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic