Healthcare Provider Details

I. General information

NPI: 1144663345
Provider Name (Legal Business Name): JANE MARIE HARTSOCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 03/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 1ST ST
CASPER WY
82601-2747
US

IV. Provider business mailing address

1900 E 1ST ST
CASPER WY
82601-2747
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-7737
  • Fax: 307-577-0049
Mailing address:
  • Phone: 307-577-7737
  • Fax: 307-577-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number25858-1082
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: