Mortenson, Duane Bruce

Mortenson, Duane Bruce is an individual health care provider with primary practice located at 555 E Broadway Ave Ste 207 , Jackson WY 83001-8640. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Mortenson, Duane Bruce can be contacted via phone (307) 733-8002.

Contact Information

Primary practice address
555 E Broadway Ave Ste 207 Jackson WY 83001-8640
Phone: (307) 733-8002
Fax: (307) 733-0032
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA818 Wyoming
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1578848487
LBN Legal business name Mortenson, Duane Bruce
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2011
Last updated May 26th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578848487 NPPES
Wyoming MEDICAID 137513000

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