Provider Demographics
NPI:1104062314
Name:EQUALITY STATE INFECTION FOUNDATION
Entity type:Organization
Organization Name:EQUALITY STATE INFECTION FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-234-8710
Mailing Address - Street 1:5810 E 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4330
Mailing Address - Country:US
Mailing Address - Phone:307-234-8710
Mailing Address - Fax:307-237-0326
Practice Address - Street 1:5810 E 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4330
Practice Address - Country:US
Practice Address - Phone:307-234-8710
Practice Address - Fax:307-237-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty