Organization
DIANE R EDWARDS
Active
Other names
Develpmental Pediatric Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE ROSE EDWARDS MD (OWNER)
(307) 472-3769
Entity
Organization
Contact information
Practice address
915 S DAVID ST, CASPER, WY 82601-3737
(307) 472-3769
(307) 472-3607
Mailing address
915 S DAVID ST, CASPER, WY 82601-3737
(307) 472-3769
(307) 472-3607
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003982141
NPI
WY
05
—
112255000
—
WY
Enumeration date
06/28/2007
Last updated
07/27/2015
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