Provider Demographics
NPI:1184243149
Name:ENIS, ELEXIS DAWN
Entity type:Individual
Prefix:MRS
First Name:ELEXIS
Middle Name:DAWN
Last Name:ENIS
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 283
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644-0283
Mailing Address - Country:US
Mailing Address - Phone:307-251-9972
Mailing Address - Fax:
Practice Address - Street 1:823 MIDWEST AVENUE
Practice Address - Street 2:
Practice Address - City:MILLS
Practice Address - State:WY
Practice Address - Zip Code:82644
Practice Address - Country:US
Practice Address - Phone:307-251-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care