Individual
JENNIFER FAVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
800 E 20TH ST STE 300, CHEYENNE, WY 82001-3882
(307) 633-7444
(307) 996-1595
Mailing address
PO BOX 20970, CHEYENNE, WY 82003-7020
(307) 996-4777
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1326
WY
363LF0000X
Family Nurse Practitioner
24857.1326
WY
363LF0000X
Family Nurse Practitioner
34857.1326
WY
Other
Enumeration date
07/14/2014
Last updated
11/15/2022
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