Healthcare Provider Details

I. General information

NPI: 1326436445
Provider Name (Legal Business Name): JESI SKRETTEBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 US HIGHWAY 20 S
BASIN WY
82410-8902
US

IV. Provider business mailing address

388 US HIGHWAY 20 S
BASIN WY
82410-8902
US

V. Phone/Fax

Practice location:
  • Phone: 307-399-0322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number43442
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: