Individual
MARY JANE NORSKOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 S 4TH ST, THERMOPOLIS, WY 82443-2634
(307) 864-3138
(307) 864-3139
Mailing address
121 S 4TH ST, THERMOPOLIS, WY 82443-2634
(307) 864-3138
(307) 864-3139
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108969204
—
WY
05
—
108969205
—
WY
05
—
132376800
—
WY
Enumeration date
12/06/2011
Last updated
07/16/2014
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