Individual
MARTI JO SIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 N 100 E, SUITE 205, GREEN RIVER, WY 82935
(307) 362-2424
(307) 222-0614
Mailing address
688 ANTELOPE DR LOT 21, ROCK SPRINGS, WY 82901-3016
(307) 274-7500
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
02/19/2016
Last updated
09/03/2020
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