Individual
RONALD STEVEN WAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
206 S 7TH ST, WORLAND, WY 82401-3308
(307) 347-6165
(307) 347-6166
Mailing address
206 S 7TH ST, WORLAND, WY 82401-3308
(307) 347-6165
(307) 347-6166
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106352900
—
WY
05
—
106352903
—
WY
Enumeration date
04/20/2011
Last updated
04/20/2011
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