Basic Information
| Provider Information | |||||||||
| NPI: | 1609363118 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRAL HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 STEVENSON RD | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820706894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077605167 | ||||||||
| FaxNumber: | 9702329367 | ||||||||
| Practice Location | |||||||||
| Address1: | 502 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820703704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077551000 | ||||||||
| FaxNumber: | 3077429717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2018 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | DUNCAN | ||||||||
| AuthorizedOfficialFirstName: | JULIA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | NP/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3077605167 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRATICTIONER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.