Healthcare Provider Details

I. General information

NPI: 1104310606
Provider Name (Legal Business Name): RENAE MARIE HEPFNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E A ST
CASPER WY
82601
US

IV. Provider business mailing address

1522 E A ST
CASPER WY
82601-2217
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-6161
  • Fax:
Mailing address:
  • Phone: 307-234-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13819A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: