Individual
NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4708 VAN BUREN AVE, CHEYENNE, WY 82009-5645
(307) 214-3888
Mailing address
4708 VAN BUREN AVE, CHEYENNE, WY 82009-5645
(307) 214-3888
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
107820-466
WY
Other
Enumeration date
10/15/2015
Last updated
10/15/2015
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