Healthcare Provider Details

I. General information

NPI: 1891241485
Provider Name (Legal Business Name): JILL VATTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 WEST BROADWAY SUITE 202
JACKSON WY
83001-8217
US

IV. Provider business mailing address

PO BOX 11359
JACKSON WY
83002-1359
US

V. Phone/Fax

Practice location:
  • Phone: 307-734-5999
  • Fax: 307-734-0345
Mailing address:
  • Phone: 307-734-5999
  • Fax: 307-734-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number29304
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: