Provider Demographics
NPI:1801041777
Name:NORRID, JEANNETTE RUTH
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:RUTH
Last Name:NORRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1714
Mailing Address - Country:US
Mailing Address - Phone:307-256-9346
Mailing Address - Fax:
Practice Address - Street 1:3506 CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1714
Practice Address - Country:US
Practice Address - Phone:307-256-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY251C00000XMedicaid