Healthcare Provider Details

I. General information

NPI: 1144982190
Provider Name (Legal Business Name): RAULI JO PERRY WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 01/13/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E HENNICK ST
PINEDALE WY
82941-5228
US

IV. Provider business mailing address

PO BOX 1333
PINEDALE WY
82941-1333
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-4133
  • Fax: 307-367-6636
Mailing address:
  • Phone: 208-404-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number53557
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number54282
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number215881
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: