Provider Demographics
NPI:1548746993
Name:DIVINE WOMENS CARE LLC
Entity Type:Organization
Organization Name:DIVINE WOMENS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, APRN
Authorized Official - Phone:307-262-5134
Mailing Address - Street 1:2032 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5081
Mailing Address - Country:US
Mailing Address - Phone:307-262-5134
Mailing Address - Fax:331-204-1133
Practice Address - Street 1:1541 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-6247
Practice Address - Country:US
Practice Address - Phone:307-262-5134
Practice Address - Fax:307-333-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY285331604367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY5B032B1FCDMedicaid