Healthcare Provider Details

I. General information

NPI: 1003951229
Provider Name (Legal Business Name): DIANE E HATTEL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 SPARKS RD SUITE 200
CHEYENNE WY
82001-6151
US

IV. Provider business mailing address

4003 RAWLINS ST
CHEYENNE WY
82001-1800
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8975
  • Fax: 307-634-9267
Mailing address:
  • Phone: 307-638-8975
  • Fax: 307-634-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16129.0890
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: