Doctor Name: | MRS. ERIN HETLAND MISCHKE |
NPI Number: | 1811291172 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | TL509 |
Business Practice Address: | 120 N C Ave Thermopolis, WY - 824432410 |
Business Phone Number: | 3078645534 |
Business Fax Number: | 3078649470 |
Mailing Address: | 120 N C Ave, Po Box 1327 THERMOPOLIS |
State: | WY |
Postal Code: | 824432410 |
Phone Number: | 3078645534 |
Fax Number: | 3078649470 |
NPI Enumeration Date: | 12/30/2010 |
NPI Last Update Date: | 12/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | TL509 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |