Individual
MONTANNA LEE MERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4003 RAWLINS ST, CHEYENNE, WY 82001-1800
(307) 632-1114
Mailing address
4811 KESTER ST, CHEYENNE, WY 82001-2085
(307) 274-6576
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1221
WY
363AS0400X
Surgical Physician Assistant
Primary
PA1221
WY
Other
Enumeration date
01/17/2024
Last updated
12/13/2024
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