Healthcare Provider Details

I. General information

NPI: 1881242816
Provider Name (Legal Business Name): JULIANNE E FORRESTER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FLAMING GORGE WAY
GREEN RIVER WY
82935-4322
US

IV. Provider business mailing address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

V. Phone/Fax

Practice location:
  • Phone: 307-212-6082
  • Fax: 307-224-2128
Mailing address:
  • Phone: 307-212-6082
  • Fax: 307-224-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44631
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number34154
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: