Healthcare Provider Details

I. General information

NPI: 1043781818
Provider Name (Legal Business Name): KATELYN MARIE LAHNERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATELYN MARIE GRANT RN

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 BEVERLY BLVD
CHEYENNE WY
82007-9133
US

IV. Provider business mailing address

1109 BEVERLY BLVD
CHEYENNE WY
82007-9133
US

V. Phone/Fax

Practice location:
  • Phone: 928-899-5817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number47904
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: