Provider Demographics
NPI:1902636251
Name:WOUND CARE OF WYOMING LLC
Entity type:Organization
Organization Name:WOUND CARE OF WYOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIRD-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-431-8287
Mailing Address - Street 1:1129 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2903
Mailing Address - Country:US
Mailing Address - Phone:307-431-8287
Mailing Address - Fax:
Practice Address - Street 1:1129 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2903
Practice Address - Country:US
Practice Address - Phone:307-431-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty