Individual
JACQUELINE JOSIE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
305 E LAKEWAY RD, GILLETTE, WY 82718-6301
(307) 696-6045
Mailing address
390 AMERICAN RD UNIT A, GILLETTE, WY 82716-9634
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-1049
WY
Other
Enumeration date
07/28/2021
Last updated
07/28/2021
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