Healthcare Provider Details

I. General information

NPI: 1295626380
Provider Name (Legal Business Name): MARC TETENMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5235 HHR RANCH RD
WILSON WY
83014-9210
US

IV. Provider business mailing address

1360 PRIMROSE LN
WILSON WY
83014-9145
US

V. Phone/Fax

Practice location:
  • Phone: 307-739-7696
  • Fax:
Mailing address:
  • Phone: 307-690-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number37831
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: