WYOMING WIC PROGRAM NPI 1366634396

NPI Information

NPI: 1366634396
Provider Name: WYOMING WIC PROGRAM
Classification: Public Health or Welfare - 251K00000X
Entity Type: Organization

CLIA Number: 53D0952972

Address:
6101 YELLOWSTONE ROAD
SUITE 510
CHEYENNE, WY
ZIP 82002
Phone: (307) 777-7494
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WYOMING WIC PROGRAM is a public health or welfare in Cheyenne, WY. WYOMING WIC PROGRAM NPI is 1366634396. The provider is registered as an organization entity type.

The provider's business location address is:

6101 YELLOWSTONE ROAD
SUITE 510
CHEYENNE, WY
ZIP 82002-001
Phone: (307) 777-7494
Fax: (307) 777-5643

The provider's authorized official is Jean A Bouley .
The authorized official title is Administrative Specialist 3 and has the following contact phone number (307) 777-7494.

The CLIA number assigned to this NPI record is 53D0952972 - public health laboratories with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/14/2007 and was last updated on 7/7/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251K00000X	Public Health or Welfare				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1366634396	MEDICAID	WYOMING

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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