Healthcare Provider Details

I. General information

NPI: 1457467607
Provider Name (Legal Business Name): PATRICIA JOAN VOLL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA JOAN KITTELSON

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 OAK STREET
SUNDANCE WY
82729-0517
US

IV. Provider business mailing address

PO BOX 517
SUNDANCE WY
82729-0517
US

V. Phone/Fax

Practice location:
  • Phone: 307-283-2476
  • Fax: 307-283-2489
Mailing address:
  • Phone: 307-283-2476
  • Fax: 307-283-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13545.065
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: