Individual
MARY DONOVAN MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1465 N 4TH ST, SUITE 119, LARAMIE, WY 82072-2066
(307) 721-0700
(307) 721-1039
Mailing address
712 S 24TH ST, LARAMIE, WY 82070-4919
(307) 755-9737
(307) 721-1039
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
6594A
WY
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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