Individual
TISHA RANEIL MARTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(307) 688-5000
(307) 688-5015
Mailing address
820 WAGON TRAIL ST, GILLETTE, WY 82718-5748
(307) 688-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
31871
WY
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
31871
WY
163WP0808X
Psychiatric/Mental Health Registered Nurse
31871
WY
Other
Enumeration date
05/14/2013
Last updated
06/05/2013
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