Individual
JEANNE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
407WEST LOUCKS ST, SHERIDAN, WY 82801
(307) 763-3039
Mailing address
407WEST LOUCKS ST, SHERIDAN, WY 82801
(307) 763-3039
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123456789
—
WY
05
—
154755100
—
WY
Enumeration date
12/09/2020
Last updated
12/09/2020
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