Individual
JACKIE ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
300 E PROSSER RD LOT 11, CHEYENNE, WY 82007-3128
(307) 635-3972
Mailing address
300 E PROSSER RD LOT 11, CHEYENNE, WY 82007-3128
(307) 635-3972
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5526
WY
Other
Enumeration date
01/23/2007
Last updated
07/08/2007
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