Individual
JULIA E ANTELOPE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
197 YELLOWCALF, ETHETE, WY 82520
(307) 438-2523
Mailing address
197 YELLOWCALF ROAD, ETHETE, WY 82520
(307) 438-2523
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
7632
WY
261QP0904X
Federal Public Health Clinic/Center
7632
WY
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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