Healthcare Provider Details

I. General information

NPI: 1306764220
Provider Name (Legal Business Name): JAN-LUKAS HAEUPTLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 N COLLEGE DR STE A
CHEYENNE WY
82001-2088
US

IV. Provider business mailing address

6058 SOUTHERN HILLS DR
WINDSOR CO
80550-8068
US

V. Phone/Fax

Practice location:
  • Phone: 307-456-1919
  • Fax:
Mailing address:
  • Phone: 307-456-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT1468
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: