Individual
ELIZABETH SMITH DANNEWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, AGPCNP-BC
Contact information
Practice address
625 E BROADWAY AVE, JACKSON, WY 83001
(307) 739-6195
(307) 739-7229
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-6195
(307) 739-7229
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
44970
WY
363LA2200X
Adult Health Nurse Practitioner
44970
WY
363LG0600X
Gerontology Nurse Practitioner
44970
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154469300
—
WY
Enumeration date
10/29/2018
Last updated
01/22/2021
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