Provider Demographics
NPI:1295540508
Name:HANWAY, SHEREACE
Entity type:Individual
Prefix:
First Name:SHEREACE
Middle Name:
Last Name:HANWAY
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 868
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0116
Mailing Address - Country:US
Mailing Address - Phone:307-463-4242
Mailing Address - Fax:
Practice Address - Street 1:902 N 8TH ST W
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2332
Practice Address - Country:US
Practice Address - Phone:307-463-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator