Provider Demographics
NPI:1619316635
Name:RANK, MICHAELA (MS)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:RANK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:PLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1671 COUGHLIN ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2321
Mailing Address - Country:US
Mailing Address - Phone:307-460-3526
Mailing Address - Fax:
Practice Address - Street 1:1050 N 3RD ST STE F
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2538
Practice Address - Country:US
Practice Address - Phone:307-460-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1619316635Medicaid