Individual
COURTNEY JO TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
209 STANFIELD AVE, CHEYENNE, WY 82007
(307) 631-1636
Mailing address
209 STANFIELD AVE, CHEYENNE, WY 82007-2308
(307) 631-1636
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/03/2017
Last updated
07/21/2022
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