Provider Demographics
NPI:1548029846
Name:WILLADSON, AMI
Entity type:Individual
Prefix:MRS
First Name:AMI
Middle Name:
Last Name:WILLADSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6568 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3685
Mailing Address - Country:US
Mailing Address - Phone:307-262-1508
Mailing Address - Fax:
Practice Address - Street 1:788 BADGER LANE
Practice Address - Street 2:
Practice Address - City:MILLS
Practice Address - State:WY
Practice Address - Zip Code:82644-5050
Practice Address - Country:US
Practice Address - Phone:307-277-5035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care