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29 Black Coal Dr, Fort Washakie, WY 82514 | |
(307) 332-7300 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Family Medicine |
Location | 29 Black Coal Dr, Fort Washakie, Wyoming |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1770328718 | NPI | - | NPPES |
Provider Name | Juliana E Ike |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1801363643 PECOS PAC ID: 1153651559 Enrollment ID: I20190927001777 |
Mailing Address | Practice Location Address |
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Po Box 128, Fort Washakie, WY 82514-0128 Ph: (307) 332-2027 | 29 Black Coal Dr, Fort Washakie, WY 82514 Ph: (307) 332-7300 |