Provider Demographics
NPI:1255970034
Name:AFFINITY FAMILY PRACTICE
Entity type:Organization
Organization Name:AFFINITY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BURAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:307-514-1523
Mailing Address - Street 1:903 S GREELEY HWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3057
Mailing Address - Country:US
Mailing Address - Phone:307-514-1523
Mailing Address - Fax:307-514-1526
Practice Address - Street 1:903 S GREELEY HWY STE A
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3057
Practice Address - Country:US
Practice Address - Phone:307-514-1523
Practice Address - Fax:307-514-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty