Basic Information
| Provider Information | |||||||||
| NPI: | 1447219852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGINEER | ||||||||
| FirstName: | NITA | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3011 | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827173011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076882600 | ||||||||
| FaxNumber: | 3076853079 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S BURMA AVE | ||||||||
| Address2: | |||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827163426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076881824 | ||||||||
| FaxNumber: | 7322713543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11594A | WY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 22896 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 22896 | SC | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 228961 | 05 | SC | MEDICAID | 100613 | 01 | NJ | PTAN MEDICARE | OTHER |