Healthcare Provider Details

I. General information

NPI: 1346534187
Provider Name (Legal Business Name): HIDIE LYNN MCCUNE BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HIDIE REEVES

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W 5TH ST
SHERIDAN WY
82801-2701
US

IV. Provider business mailing address

909 LONG DR STE C
SHERIDAN WY
82801-3282
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-5534
  • Fax: 307-673-5167
Mailing address:
  • Phone: 307-672-8958
  • Fax: 307-673-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: