Provider Demographics
NPI:1255853099
Name:NOSTRUM, JANETTE (RBT)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:NOSTRUM
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 PENDELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644
Mailing Address - Country:US
Mailing Address - Phone:307-215-1032
Mailing Address - Fax:
Practice Address - Street 1:945 PENDELL BLVD.
Practice Address - Street 2:
Practice Address - City:MILLS
Practice Address - State:WY
Practice Address - Zip Code:82644
Practice Address - Country:US
Practice Address - Phone:307-215-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician