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NPI Code Detail

MEDICARE: JULIE ELVESTAD

MEDICARE: JULIE ELVESTAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1316488653
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE ELVESTAD
Provider Business Mailing Address
First Line : PO BOX 393
Second Line :
City : CASPER
State : WY
Zip : 82602-0393
Country : US
Telephone Number : 307-577-4913
Fax Number : 307-577-4014
Provider Business Practice Location Address
First Line : 4070 PLAZA DR STE 106
Second Line :
City : CASPER
State : WY
Zip : 82604-4296
Country : US
Telephone Number : 307-577-4913
Fax Number : 307-577-4014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2017
Last Update Date : 03/20/2017

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Directions to “ JULIE ELVESTAD ” Practice Location

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