Healthcare Provider Details

I. General information

NPI: 1659683597
Provider Name (Legal Business Name): J L GLOVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 CRESCENT AVE
CASPER WY
82604-3292
US

IV. Provider business mailing address

PO BOX 4668
CASPER WY
82604-0668
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-2269
  • Fax:
Mailing address:
  • Phone: 307-234-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: JANINE LOUISE GLOVER
Title or Position: OWNER/MEMBER
Credential:
Phone: 307-234-2269