Healthcare Provider Details

I. General information

NPI: 1851539043
Provider Name (Legal Business Name): LAURIE DEE HIPWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 YELLOWSTONE AVE STE 320
CODY WY
82414
US

IV. Provider business mailing address

707 SHERIDAN AVE
CODY WY
82414-3409
US

V. Phone/Fax

Practice location:
  • Phone: 307-578-2890
  • Fax:
Mailing address:
  • Phone: 307-527-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberARNP 9286348
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number36156.1422
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: