Individual
LOUISA BENSON MOOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
28 BLACK COAL DR, FORT WASHAKIE, WY 82514
(307) 332-7300
Mailing address
PO BOX 128, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
(406) 563-8694
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12601A
WY
208000000X
Pediatrics Physician
60386546
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710229810
NPS
MT
Enumeration date
03/27/2013
Last updated
02/14/2020
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