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Search › Wyoming › 183500000X

Colter Haderlie

NPI 1699143107 · on the registry since 2015 · sole proprietor

Practice

Address
679 S Washington St
Afton, WY 83110
Phone
(307) 885-9804
Fax
(307) 885-9760
Organisation at this address
Shopko Stores Operating Co Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
183500000X
183500000X
Licence states on file
WY
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2015-09-14

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Wyoming