| Organization Name: | ANTELOPE MEDICAL CONSULTANTS LLC |
| NPI Number: | 1124188545 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA ANNE MALODY (OWNER) |
| Mailing Address: | 430 S Medical Arts Ct Gillette |
| State: | WY US |
| Postal Code: | 827163364 |
| Phone Number: | 3076827661 |
| Fax Number: | 3076825074 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18882.269 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |