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NPI Code Detail

MEDICARE: MRS. CAROL LEE QUILLEN P.A.-C.

MEDICARE: MRS. CAROL LEE QUILLEN P.A.-C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant286WY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00137358OTHERWYMEDICARE RAILROAD RETIREM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2301811OTHERWYBLUE SHIELD

General Provider Information

NPI Number : 1093801664
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAROL LEE QUILLEN P.A.-C.
Provider Business Mailing Address
First Line : 745 BUENA VISTA DR
Second Line :
City : LANDER
State : WY
Zip : 82520-3431
Country : US
Telephone Number : 307-332-2941
Fax Number : 307-332-2068
Provider Business Practice Location Address
First Line : 745 BUENA VISTA DR
Second Line :
City : LANDER
State : WY
Zip : 82520-3431
Country : US
Telephone Number : 307-332-2941
Fax Number : 307-332-2068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. CAROL LEE QUILLEN P.A.-C.” Practice Location

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