Healthcare Provider Details

I. General information

NPI: 1003705922
Provider Name (Legal Business Name): MICHELLE LYNN UKELE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 E 2ND ST
CASPER WY
82601-2926
US

IV. Provider business mailing address

4259 DARTFORD CT
CASPER WY
82609-3873
US

V. Phone/Fax

Practice location:
  • Phone: 307-577-7201
  • Fax:
Mailing address:
  • Phone: 307-259-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number47005
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: