Individual
MARTHA VANTASSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
510 W 29TH ST, CHEYENNE, WY 82001-2760
(307) 632-9362
Mailing address
510 W 29TH ST, CHEYENNE, WY 82001-2760
(307) 632-9362
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
29775
WY
163WC0400X
Case Management Registered Nurse
29775
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902259203
NPI
WY
Enumeration date
08/16/2016
Last updated
04/13/2022
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