Provider Demographics
NPI:1215767652
Name:GEORGE, LANDON NEVES (NP, RN)
Entity type:Individual
Prefix:
First Name:LANDON
Middle Name:NEVES
Last Name:GEORGE
Suffix:
Gender:M
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-0132
Mailing Address - Country:US
Mailing Address - Phone:307-431-8126
Mailing Address - Fax:
Practice Address - Street 1:902 BLACKBURN ST STE F
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8494
Practice Address - Country:US
Practice Address - Phone:307-291-0447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY45851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily