Provider Demographics
NPI:1154671154
Name:CECRLE, JESSICA L (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CECRLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DUTCH ED LANE
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-0000
Mailing Address - Country:US
Mailing Address - Phone:307-349-5281
Mailing Address - Fax:307-332-0131
Practice Address - Street 1:29 DUTCH ED LANE
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-0000
Practice Address - Country:US
Practice Address - Phone:307-349-5281
Practice Address - Fax:307-332-0131
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY29411163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse