OrganizationActive
Mountain Sage Holistic Clinic, LLC
NPI 1376924621 · Primary Care Nurse Practitioner · Dubois, WY
Provider details
- NPI number
- 1376924621
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Martin Baum, Business Manager(307) 455-2807
- License
- 33105.1295 (WY)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1428 Warm Springs Dr
Dubois, WY 82513-1428
Phone: (307) 455-2807
Fax: (307) 455-2809
Approximate (ZIP-level) locationGet directions
Mailing address
1428 Warm Springs Dr
Dubois, WY 82513-1428
Registry dates
- Enumerated
- 2015-06-12
- Last updated
- 2015-06-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.