Provider Demographics
NPI:1780420612
Name:COLSON, PIYANUCH
Entity type:Individual
Prefix:
First Name:PIYANUCH
Middle Name:
Last Name:COLSON
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 1:4095 PLACID DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-5014
Mailing Address - Country:US
Mailing Address - Phone:307-267-4365
Mailing Address - Fax:
Practice Address - Street 1:4095 PLACID DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-5014
Practice Address - Country:US
Practice Address - Phone:307-267-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator