Individual
AMANDA STACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 AVENUE C., LOT 1, CHEYENNE, WY 82007-1822
(307) 220-5575
Mailing address
3730 RAWLINS ST, CHEYENNE, WY 82001-1822
(307) 220-5575
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/16/2019
Last updated
05/02/2024
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