Individual
MRS. CAROL LEE QUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-2068
Mailing address
745 BUENA VISTA DR, LANDER, WY 82520-3431
(307) 332-2941
(307) 332-2068
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
286
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
301811
BLUE SHIELD
WY
01
—
P00137358
MEDICARE RAILROAD RETIREM
WY
Enumeration date
10/04/2006
Last updated
07/08/2007
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