Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 13022A | WY |
NPI | 1386199958 |
---|---|
Provider Name | Christina Elize Aquino Jara |
First Address | Casper, WY 82609-4533 |
Second Address | Casper, WY 82601-3921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 16/09/2020 |