Organization
WYOMING WELLNESS CENTER LLC
Active
Parent organization
WYOMING WELLNESS CENTER LLC
Other names
Wyoming Wellness Center - Ketamine
Organization subpart
Yes
Provider details
NPI number
Legal business name
WYOMING WELLNESS CENTER LLC
Authorized official
TRACY RENE' RICHARD CRNA (OWNER / PROVIDER)
(307) 532-3035
Entity
Organization
Contact information
Practice address
601 NIOBRARA AVE, TORRINGTON, WY 82240-1522
(307) 532-3035
(307) 275-9533
Mailing address
601 NIOBRARA AVE, TORRINGTON, WY 82240-1522
(307) 532-3035
(307) 275-9533
Taxonomy
Speciality
Code
Description
License number
State
163WP0000X
Pain Management Registered Nurse
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
08/03/2024
Last updated
08/27/2024
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