Provider Demographics
NPI:1780334466
Name:WYOMING WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:WYOMING WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RENE'
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA / APRN
Authorized Official - Phone:307-532-3035
Mailing Address - Street 1:601 NIOBRARA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1522
Mailing Address - Country:US
Mailing Address - Phone:307-532-3035
Mailing Address - Fax:307-275-9533
Practice Address - Street 1:601 NIOBRARA AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1522
Practice Address - Country:US
Practice Address - Phone:307-532-3035
Practice Address - Fax:307-275-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty