Basic Information
Provider Information
NPI: 1881296515
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOWNEY
FirstName: ECHO
MiddleName: ORA ROSE
NamePrefix:  
NameSuffix:  
Credential: PMHNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6301 TASSEL AVE
Address2:  
City: GILLETTE
State: WY
PostalCode: 827187674
CountryCode: US
TelephoneNumber: 3072994088
FaxNumber:  
Practice Location
Address1: 501 S BURMA AVE
Address2:  
City: GILLETTE
State: WY
PostalCode: 827163426
CountryCode: US
TelephoneNumber: 3076881000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/09/2020
LastUpdateDate: 04/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X47506WYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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