Organization
PAINTBRUSH PEDIATRICS, LC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELIN FOSS HARDENBROOK MD (OWNER)
(307) 733-6520
Entity
Organization
Contact information
Practice address
555 E BROADWAY AVE STE 202, JACKSON, WY 83001-8640
(307) 733-6520
(307) 733-3216
Mailing address
PO BOX 4182, JACKSON, WY 83001-4182
(307) 733-6520
(307) 733-3216
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568039600
NPI
—
01
—
1669891099
NPI
—
01
—
1750466405
NPI
—
Enumeration date
07/04/2022
Last updated
07/04/2022
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