Individual
MELISSA ROSE PINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
29 BLACKCOLE ROAD, FORT WASHAKIE, WY 82514
(307) 332-7300
(307) 332-5753
Mailing address
PO BOX 104, FORT WASHAKIE, WY 82514-0104
(208) 497-4709
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
41162
WY
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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