Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 22630.1461 | WY |
N | 363LG0600X | Nurse Practitioner - Gerontology | 22630.1461 | WY |
NPI | 1043683691 |
---|---|
Provider Name | Patricia Mcjilton |
First Address | Gillette, WY 82716-3426 |
Second Address | Gillette, WY 82716-3426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2015 |
Last Update Date | 04/11/2015 |