Organization
TETON PEDIATRICS PC
Active
Other names
Teton Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELIN FOSS HARDENBROOK MD (OWNER)
(307) 733-6520
Entity
Organization
Contact information
Practice address
555 E BROADWAY AVE STE 202, JACKSON, WY 83001-8640
(307) 733-6520
(307) 733-3216
Mailing address
PO BOX 4182, JACKSON, WY 83001-4182
(307) 733-6520
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
11/18/2020
Last updated
12/01/2020
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