Provider Demographics
NPI:1619149226
Name:EQUALITY STATE INFECTION FOUNDATION
Entity Type:Organization
Organization Name:EQUALITY STATE INFECTION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-234-8700
Mailing Address - Street 1:5810 E 2ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4329
Mailing Address - Country:US
Mailing Address - Phone:307-234-8700
Mailing Address - Fax:307-234-8750
Practice Address - Street 1:5810 E 2ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4329
Practice Address - Country:US
Practice Address - Phone:307-234-8700
Practice Address - Fax:307-234-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty