Individual
DIVA BERMUDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 CENTER ST, EVANSTON, WY 82930-3383
(307) 789-0241
Mailing address
100 HARRISON DR UNIT 1011, EVANSTON, WY 82931-0658
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/11/2017
Last updated
06/13/2021
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