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Organization

WYOMING WIC PROGRAM

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEAN A BOULEY (ADMINISTRATIVE SPECIALIST 3)
(307) 777-7494
Entity
Organization

Contact information

Practice address
6101 YELLOWSTONE ROAD, SUITE 510, CHEYENNE, WY 82002-0001
(307) 777-7494
(307) 777-5643
Mailing address
6101 YELLOWSTONE ROAD, SUITE 510, CHEYENNE, WY 82002-0001
(307) 777-7494
(307) 777-5643

Taxonomy

Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1366634396
WY
Enumeration date
08/14/2007
Last updated
07/07/2008
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