Provider Demographics
NPI:1780423814
Name:TONGUE RIVER VALLEY WALK-IN CLINIC
Entity type:Organization
Organization Name:TONGUE RIVER VALLEY WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GLENNDA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:307-752-6440
Mailing Address - Street 1:222 US HIGHWAY 14
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHESTER
Mailing Address - State:WY
Mailing Address - Zip Code:82839-0486
Mailing Address - Country:US
Mailing Address - Phone:307-752-6440
Mailing Address - Fax:
Practice Address - Street 1:222 US HIGHWAY 14
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHESTER
Practice Address - State:WY
Practice Address - Zip Code:82839-0486
Practice Address - Country:US
Practice Address - Phone:307-752-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty