Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033577333 |
---|---|
Provider Name | Suzette Jewel |
First Address | Lovell, WY 82431-1934 |
Second Address | Lovell, WY 82431-1934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2016 |
Last Update Date | 02/02/2016 |