Provider Information for 1801025655
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EDEN MARIE WEST PCSW
Other Names:Former Name:EDEN MARIE HINTZSex: Female
NPI: 1801025655
Last Updated: 2012-10-01
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801025655 | ||||||||
| Enumeration Date | 2009-07-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 113 GILLETTE AVE. SUITE 203 GILLETTE, WY 82716-3741 United States Phone: 307-685-6982 | Fax:307-685-8054 | ||||||||
| Primary Practice Address | 113 S GILLETTE AVE SUITE 203 GILLETTE, WY 82716-3740 United States Phone: 307-685-6982 | Fax:307-685-8054 | ||||||||
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