Provider Demographics
NPI:1013940055
Name:COUNTY OF SUBLETTE
Entity Type:Organization
Organization Name:COUNTY OF SUBLETTE
Other - Org Name:SUBLETTE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DERETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHLHAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:307-367-2157
Mailing Address - Street 1:619 E. HENNICK ST.
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0517
Mailing Address - Country:US
Mailing Address - Phone:307-367-2157
Mailing Address - Fax:307-367-2689
Practice Address - Street 1:619 E. HENNICK STREET
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-0517
Practice Address - Country:US
Practice Address - Phone:307-367-2157
Practice Address - Fax:307-367-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY106499101251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare