Provider Demographics
NPI:1760820997
Name:TELANDER, LANCE R
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:R
Last Name:TELANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 GREENWAY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5970
Mailing Address - Country:US
Mailing Address - Phone:307-778-8686
Mailing Address - Fax:307-778-8681
Practice Address - Street 1:4007 GREENWAY ST STE 201
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5970
Practice Address - Country:US
Practice Address - Phone:307-778-8686
Practice Address - Fax:307-778-8681
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator