Individual
MS. JOANN BOURLIER-CHILDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 634-2273
Mailing address
214 E 23RD ST, CHEYENNE, WY 82001-3748
(307) 634-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
463
WY
363A00000X
Physician Assistant
NE692
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
49876317
—
CO
05
—
NE692
—
NE
Enumeration date
01/11/2006
Last updated
01/13/2010
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