Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner | |
Rural Health |
261QR1300X | B4[14] | Rural Health Clinic |
| NPI # | 1487295846 |
| LBN Legal business name | HOLISTIC PAIN MANAGEMENT OF WYOMING, LLC |
| Authorized official | RYAN SHEDD - (CEO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/07/2019 |
| Last updated | 10/20/2022 - About 4 years ago |
| Identifiers | n/a |
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