MOUNTAIN SAGE HOLISTIC CLINIC LLC, Primary Care DUBOIS, WY

Contact Information

MOUNTAIN SAGE HOLISTIC CLINIC, LLC

1428 WARM SPRINGS DR
DUBOIS, WY 82513-1428

Phone: 307-455-2807
Fax: 307-455-2809
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Primary Care	363LP2300X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for MOUNTAIN SAGE HOLISTIC CLINIC LLC · (Female)

NPI Number	`1376924621`
Status	Active
Credentials
Entity	Individual
Enumeration date	06/12/2015
Last updated	06/12/2015 - About 11 years ago
Sole proprietor ¹	Not specified
Identifiers	WY License # 33105.1295 WY Medicaid 136115500
Hospital affiliation(s)	Not Available

¹ A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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