Individual
RACHEL LYNN TIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1898 FORT RD, SHERIDAN, WY 82801-8320
(307) 672-3473
Mailing address
105 LAKE DESMET RD, BUFFALO, WY 82834-9506
(920) 296-9270
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
240843
WI
Other
Enumeration date
02/25/2019
Last updated
02/25/2019
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