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NPI Profile for PONY EXPRESS PEDIATRICS LLC in CHEYENNE, WY.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Pediatrics |
363LP0200X | 50 | Nurse Practitioner |
| NPI # | 1265087993 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/08/2019 | |
| Last updated | 08/08/2019 - About 7 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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PONY EXPRESS PEDIATRICS, LLC