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General NPI Number Information
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NPI Number | 1427772516
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Entity Type | Individual
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Provider Name | HARLIE HIMMELBERG
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Gender | Female
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1026 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2902
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Country | US
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Telephone | 307-333-0002
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Fax | 307-202-5112
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Provider Business Mailing Address
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Address Line | 1026 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2902
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Country | US
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Telephone | 402-621-0599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1095
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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