Organization
GOOSE CREEK FAMILY PRACTICE, P.C.
Active
Organization
GOOSE CREEK FAMILY PRACTICE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA ANN KAWULOK FNP-C (PRESIDENT)
(307) 674-1744
Entity
Organization
Contact information
Practice address
304 COFFEEN AVE, SUITE A, SHERIDAN, WY 82801-4803
(307) 674-1744
(307) 674-1752
Mailing address
304 COFFEEN AVE, SUITE A, SHERIDAN, WY 82801-4803
(307) 674-1744
(307) 674-1752
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
11988.1019
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013242502
NPI #
—
Enumeration date
07/22/2011
Last updated
11/09/2012
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