Provider Demographics
NPI:1336218890
Name:WOOLSEY, MARY H (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1551 BRICE ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3505
Mailing Address - Country:US
Mailing Address - Phone:307-322-3861
Mailing Address - Fax:
Practice Address - Street 1:1551 BRICE ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3505
Practice Address - Country:US
Practice Address - Phone:307-322-3861
Practice Address - Fax:307-322-2018
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12782.0863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily