Provider Demographics
NPI:1740531599
Name:ANTELOPE, JULIA E (LPN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:ANTELOPE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 YELLOWCALF ROAD
Mailing Address - Street 2:
Mailing Address - City:ETHETE
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-438-2523
Mailing Address - Fax:
Practice Address - Street 1:197 YELLOWCALF
Practice Address - Street 2:
Practice Address - City:ETHETE
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-438-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7632164W00000X, 261QP0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal