Basic Information
| Provider Information | |||||||||
| NPI: | 1982713764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITESELL | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7124 COMMONS DR UNIT C | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264060 | ||||||||
| FaxNumber: | 3074264061 | ||||||||
| Practice Location | |||||||||
| Address1: | 7124 COMMONS DR UNIT C | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820092620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3074264060 | ||||||||
| FaxNumber: | 3074264061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 03/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 337 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | PA0002070 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.