Basic Information
| Provider Information | |||||||||
| NPI: | 1932458262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEITCHLER | ||||||||
| FirstName: | VITORIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 S WASHINGTON ST | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075774220 | ||||||||
| FaxNumber: | 3072350931 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 SOUTH WASHINGTON | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 82601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3075774220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 06/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.