Individual
JERI L MARKWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7539 E GEARY DOME RD, EVANSVILLE, WY 82636-9692
(307) 797-0827
Mailing address
7539 E GEARY DOME RD, EVANSVILLE, WY 82636-9692
(307) 797-0827
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127038900
—
WY
Enumeration date
03/22/2010
Last updated
03/22/2010
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