Provider Demographics
NPI:1215953385
Name:RABON, AMY M (CNM,MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:RABON
Suffix:
Gender:F
Credentials:CNM,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1387
Mailing Address - Country:US
Mailing Address - Phone:307-763-8701
Mailing Address - Fax:307-224-2293
Practice Address - Street 1:110 S GOULD ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6321
Practice Address - Country:US
Practice Address - Phone:307-763-8701
Practice Address - Fax:307-224-2293
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY22464.343363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110391101Medicaid