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Contact Information

JUSTIN G TATTERSALL
625 E BROADWAY AVE
JACKSON, WY83001-8642
 Phone: 307-733-3636
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Registered Nurse First Assistant

163WR0006X
Indicates primary specialty

NPI Profile & details for JUSTIN G TATTERSALL · (Male)

NPI # 1518479104
Status Active
Credentials
Entity Individual
Enumeration date 11/03/2017
Last updated 11/03/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • WY License # 30955
  • Other 3074130437 NONE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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