Provider Demographics
NPI:1649410580
Name:COUDRAY, CATHERINE RAHM (LIC AP DILP AC OMD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:RAHM
Last Name:COUDRAY
Suffix:
Gender:F
Credentials:LIC AP DILP AC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E GRAND AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5268
Mailing Address - Country:US
Mailing Address - Phone:321-303-5240
Mailing Address - Fax:321-244-0453
Practice Address - Street 1:2900 E GRAND AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5268
Practice Address - Country:US
Practice Address - Phone:321-303-5240
Practice Address - Fax:321-244-0453
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYAP32171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1649410580OtherCOMMERCIAL
WYAP32OtherACUPUNCTURE LIC