| Hometown Freedom Healthcare, Llc | |
|
705 E Washington Ave Riverton WY 82501-4452 | |
| (307) 463-0541 | |
| (307) 463-0494 |
| Full Name | Hometown Freedom Healthcare, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 705 E Washington Ave, Riverton, Wyoming |
| Authorized Official Name and Position | Enedina Vasco (EMPLOYEE, OWNER) |
| Authorized Official Contact | 3074630541 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hometown Freedom Healthcare, Llc 705 E Washington Ave Riverton WY 82501-4452 Ph: (307) 463-0541 | Hometown Freedom Healthcare, Llc 705 E Washington Ave Riverton WY 82501-4452 Ph: (307) 463-0541 |
| NPI Number | 1093447021 |
|---|---|
| Provider Enumeration Date | 06/28/2022 |
| Last Update Date | 08/30/2023 |
| Medicare PECOS PAC ID | 0042688822 |
|---|---|
| Medicare Enrollment ID | O20221129001510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093447021 | NPI | - | NPPES |
| Provider Name | Enedina Vasco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669089652 PECOS PAC ID: 1557781507 Enrollment ID: I20221129003385 |
| Provider Name | Tara Blumenshine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588026009 PECOS PAC ID: 8628359262 Enrollment ID: I20230130001420 |
| Provider Name | Dawn Marie Dubeau |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1225722879 PECOS PAC ID: 7719340207 Enrollment ID: I20230922001147 |
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