Provider Demographics
NPI:1952709453
Name:LAURIENTI, MICHELLE BERNADETTE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:BERNADETTE
Last Name:LAURIENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:BERNADETTE
Other - Last Name:SILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 EDINBURGH STREET
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301
Mailing Address - Country:US
Mailing Address - Phone:307-324-8820
Mailing Address - Fax:307-333-0261
Practice Address - Street 1:1800 EDINBURGH STREET
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301
Practice Address - Country:US
Practice Address - Phone:307-324-8820
Practice Address - Fax:307-333-0261
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No174400000XOther Service ProvidersSpecialist
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1629301429Medicaid