Organization
MOUNTAIN SAGE HOLISTIC CLINIC, LLC
Active
Organization
MOUNTAIN SAGE HOLISTIC CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN P BAUM (BUSINESS MANAGER)
(307) 455-2807
Entity
Organization
Contact information
Practice address
1428 WARM SPRINGS DR, DUBOIS, WY 82513-1428
(307) 455-2807
(307) 455-2809
Mailing address
1428 WARM SPRINGS DR, DUBOIS, WY 82513-1428
(307) 455-2807
(307) 455-2809
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
33105.1295
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136115500
—
WY
Enumeration date
06/12/2015
Last updated
06/12/2015
Update your record
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