Provider Demographics
NPI:1548530579
Name:TREFETHEN, AMYE L (BA JD)
Entity type:Individual
Prefix:
First Name:AMYE
Middle Name:L
Last Name:TREFETHEN
Suffix:
Gender:F
Credentials:BA JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2343
Mailing Address - Country:US
Mailing Address - Phone:307-745-8915
Mailing Address - Fax:307-745-8761
Practice Address - Street 1:1263 N 15TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2343
Practice Address - Country:US
Practice Address - Phone:307-745-8915
Practice Address - Fax:307-745-8761
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker