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General NPI Number Information
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NPI Number | 1184800674
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Entity Type | Organization
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Legal Business Name | WILLOW CREEK FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 4003 RAWLINS ST.
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City | CHEYENNE
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State | WY
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Zip | 82001-1800
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Country | US
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Telephone | 307-638-8975
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Fax | 307-634-9267
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Provider Business Mailing Address
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Address Line | 4003 RAWLINS ST
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City | CHEYENNE
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State | WY
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Zip | 82001-1800
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Country | US
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Telephone | 307-638-8975
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Fax | 307-634-9267
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Authorized Official
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Title or Position | OWNER
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Name | DIANE E HATTEL
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Credential | FNP-C
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Telephone | 307-638-8975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16129.0890
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License Number State | WY
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