MEDICARE: CHARLOTTE DIPRISCO M.S., P.P.C.

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
1	101Y00000X	Counselor	PPC-886	WY

General Provider Information

NPI Number	:	1457701229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE DIPRISCO M.S., P.P.C.

Provider Business Mailing Address
First Line	:	140 E BROADWAY AVE
Second Line	:	STE. B-13
City	:	JACKSON
State	:	WY
Zip	:	83001-8632
Country	:	US
Telephone Number	:	307-413-6528
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 E BROADWAY AVE
Second Line	:	STE. B-13
City	:	JACKSON
State	:	WY
Zip	:	83001-8632
Country	:	US
Telephone Number	:	307-413-6528
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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