Individual
TAVIS RASNAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2526 SEYMOUR AVE, CHEYENNE, WY 82001-3159
(307) 634-9653
(307) 638-8256
Mailing address
2526 SEYMOUR AVE, CHEYENNE, WY 82001-3159
(307) 634-9653
(307) 638-8256
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
PPC-975
WY
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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