Individual
AMY R SURDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
433 E 19TH ST, CHEYENNE, WY 82001-4643
(307) 635-5393
(307) 635-2199
Mailing address
PO BOX 20170, CHEYENNE, WY 82003-7004
(307) 635-5393
(307) 635-2199
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
18161.0312
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121544200
—
WY
01
—
23339
WINHEALTH PARTNERS
WY
01
—
313763
BLUE SHIELD
WY
01
—
82009A055
WPS TRIWEST
WY
01
—
P00251860
RAILROAD MEDICARE
WY
Enumeration date
07/21/2006
Last updated
06/28/2012
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