Mary Grussendorf
Individual provider Active NPI Case Manager/Care Coordinator · Evansville, WY
NPI 1619345477 · NPPES record last updated Sep 10, 2015
Key facts
- NPI
- 1619345477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 108766882 (WY)
- Practice address
- 721 Reshaw Cir
Evansville, WY 82636-9410 - Phone
- (307) 277-5401
- NPI assigned
- Sep 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108766882 | WY | MD | Case Manager/Care Coordinator |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 108766882 | WY | Yes |
Addresses
Primary practice location
721 Reshaw Cir
Evansville, WY 82636-9410
Mailing address
721 Reshaw Cir
Evansville, WY 82636-9410
Phone (307) 277-5401
Other providers in Evansville, WY
- Sheila Frisby
- Jennifer Anne Gallagher
- Sarah Gillham
- Joan Goodale
- Karen L. Graves
- Laura Johnson
- Brenda Koehn
- Sharon Tamabine Kuykendall
- Sarah Alyce Larsen
- Velvet Dawn Locklin
All providers in Evansville, WY · Case Manager/Care Coordinator in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.