Provider Demographics
NPI:1063048411
Name:LEMASTER, MISTY
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:LEMASTER
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 1:717 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1246
Mailing Address - Country:US
Mailing Address - Phone:307-256-4270
Mailing Address - Fax:
Practice Address - Street 1:127 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:WY
Practice Address - Zip Code:82053-5020
Practice Address - Country:US
Practice Address - Phone:307-256-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health