Individual
JEREMIAH CHARLES ETCHEVERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2300 FOOTHILL BLVD, ROCK SPRINGS, WY 82901-5610
(307) 352-6677
Mailing address
2300 FOOTHILL BLVD, ROCK SPRINGS, WY 82901-5610
(307) 352-6677
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/07/2012
Last updated
10/17/2016
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