Provider Demographics
NPI:1023256377
Name:BAIELY, MILSOM JUNE
Entity type:Individual
Prefix:MRS
First Name:MILSOM
Middle Name:JUNE
Last Name:BAIELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MILSOM
Other - Middle Name:JUNE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2004 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3135
Mailing Address - Country:US
Mailing Address - Phone:307-856-7078
Mailing Address - Fax:
Practice Address - Street 1:710 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3340
Practice Address - Country:US
Practice Address - Phone:307-856-7182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY3148430OtherPROVIDER NUMBER