Provider Demographics
NPI:1306337811
Name:EMERSON, DAKOTA RAEN
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:RAEN
Last Name:EMERSON
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 1:1158 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2342
Mailing Address - Country:US
Mailing Address - Phone:254-217-0237
Mailing Address - Fax:
Practice Address - Street 1:1158 N 19TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2342
Practice Address - Country:US
Practice Address - Phone:254-217-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator