Individual
TRICIA M MIEDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
901 ADAMS ST, AFTON, WY 83110-9621
(307) 885-5800
Mailing address
901 ADAMS ST, AFTON, WY 83110-9621
(307) 885-5800
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
R79477
AZ
207P00000X
Emergency Medicine Physician
Primary
TL8682
WY
363A00000X
Physician Assistant
5601006114
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023390507
—
MI
01
—
1588778484
BCBSM - WMCC
MI
Enumeration date
09/12/2011
Last updated
07/01/2025
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