Organization
WYOMING REGIONAL ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY L GREEN MS CRNA (MANAGING MEMBER)
(307) 358-5590
Entity
Organization
Contact information
Practice address
111 S 5TH STREET, DOUGLAS, WY 82633
(307) 358-2122
Mailing address
PO BOX 1780, DOUGLAS, WY 82633-1780
(307) 358-5590
(307) 358-5590
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0616001
BCBS
WY
01
—
DA5920
RAILROAD MC
—
Enumeration date
11/15/2006
Last updated
08/22/2020
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