Provider Demographics
NPI:1659616308
Name:MEDDERS, MAURICA RAE
Entity Type:Individual
Prefix:MS
First Name:MAURICA
Middle Name:RAE
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82602-0393
Mailing Address - Country:US
Mailing Address - Phone:307-577-4913
Mailing Address - Fax:307-577-4014
Practice Address - Street 1:355 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2037
Practice Address - Country:US
Practice Address - Phone:307-577-4913
Practice Address - Fax:307-577-4014
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator