Individual
MARY PAULINE KILLSONTOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24 GREAT PLAINS RD., ARAPAHOE, WY 82510
(307) 856-0470
Mailing address
24 GREAT PLAINS RD., ARAPAHOE, WY 82510
(307) 856-0470
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-5206746
—
WY
Enumeration date
02/12/2020
Last updated
02/12/2020
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