Individual
SHAWNA MICHELE WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 MAJOR AVE, RIVERTON, WY 82501-2342
(307) 856-6587
(833) 825-6587
Mailing address
146 LEFT HAND DITCH RD, RIVERTON, WY 82501-9135
(307) 855-9219
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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