Healthcare Provider Details

I. General information

NPI: 1316119639
Provider Name (Legal Business Name): DIANE C. HENSHAW, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E 2ND ST
CASPER WY
82609-4293
US

IV. Provider business mailing address

6501 E 2ND ST
CASPER WY
82609-4293
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-5433
  • Fax: 307-233-4705
Mailing address:
  • Phone: 307-235-5433
  • Fax: 307-233-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number6076A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number6076A
License Number StateWY

VIII. Authorized Official

Name: MRS. DIANE C. HENSHAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-235-5433