Provider Demographics
NPI:1962889303
Name:CURTIS, AIYANNA
Entity type:Individual
Prefix:
First Name:AIYANNA
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIYANNA
Other - Middle Name:
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 IRVINE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-9528
Mailing Address - Country:US
Mailing Address - Phone:307-358-5193
Mailing Address - Fax:307-358-3438
Practice Address - Street 1:809 S 9TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2959
Practice Address - Country:US
Practice Address - Phone:307-358-5193
Practice Address - Fax:307-358-3438
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst