Organization
DIANA LEE MARTIN
Active
Organization
DIANA LEE MARTIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA LEE MARTIN RN (OWNER)
(307) 747-8035
Entity
Organization
Contact information
Practice address
2805 STATE HIGHWAY 411, FORT BRIDGER, WY 82933
(307) 747-8035
Mailing address
PO BOX 512, FORT BRIDGER, WY 82933-0512
(307) 747-8035
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
08/22/2024
Last updated
08/22/2024
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