Healthcare Provider Details

I. General information

NPI: 1144272394
Provider Name (Legal Business Name): CATHERINE MARIE DEPALMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/19/2022
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FEATHER WAY
EVANSTON WY
82930-9227
US

IV. Provider business mailing address

195 FEATHER WAY
EVANSTON WY
82930-9227
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-1102
  • Fax: 307-789-9273
Mailing address:
  • Phone: 307-789-1102
  • Fax: 307-789-9273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7258A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: