Provider Demographics
NPI:1114255726
Name:TRAVIS, LAUREL FRANCES
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:FRANCES
Last Name:TRAVIS
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 1:3664 WILSON WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4915
Mailing Address - Country:US
Mailing Address - Phone:307-371-6719
Mailing Address - Fax:307-362-4615
Practice Address - Street 1:3664 WILSON WAY
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4915
Practice Address - Country:US
Practice Address - Phone:307-371-6719
Practice Address - Fax:307-362-4615
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator