Provider Demographics
NPI:1770636276
Name:COUNTY OF NIOBRARA
Entity type:Organization
Organization Name:COUNTY OF NIOBRARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNTY NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-286-0220
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0998
Mailing Address - Country:US
Mailing Address - Phone:307-334-4032
Mailing Address - Fax:
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-5094
Practice Address - Country:US
Practice Address - Phone:307-334-4032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY109199900Medicaid
WY109199900Medicaid