Individual
SALLY J YOUNGBEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
29 BLACK COAL DR, FORT WASHAKIE, WY 82514-0128
(307) 332-7300
(307) 332-0131
Mailing address
185 CUSTER ST, APT 5, LANDER, WY 82520
(614) 481-0683
(307) 332-0131
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
125860
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105726000
—
WY
Enumeration date
02/10/2011
Last updated
02/10/2011
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