Provider Demographics
NPI:1346507761
Name:MUNSON, MARY LESLEE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LESLEE
Last Name:MUNSON
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 1:54 SEYMOUR ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9208
Mailing Address - Country:US
Mailing Address - Phone:307-673-0540
Mailing Address - Fax:307-673-0718
Practice Address - Street 1:54 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-9208
Practice Address - Country:US
Practice Address - Phone:307-673-0540
Practice Address - Fax:307-673-0718
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator