Provider Demographics
NPI:1417396870
Name:BASS, JILL ROCCARO (APRN, CSN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ROCCARO
Last Name:BASS
Suffix:
Gender:F
Credentials:APRN, CSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 COMMERCIAL WAY STE 20
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4705
Mailing Address - Country:US
Mailing Address - Phone:307-212-6270
Mailing Address - Fax:
Practice Address - Street 1:170 ARROWHEAD DR STE 2
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9307
Practice Address - Country:US
Practice Address - Phone:307-212-6270
Practice Address - Fax:307-212-6271
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY320000.1245163WP0000X
WY320001245364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WP0000XNursing Service ProvidersRegistered NursePain Management