MEDICARE: MICHELLE LEE HIPSAK DNP, APRN, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20480.1809	WY

General Provider Information

NPI Number	:	1134694383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEE HIPSAK DNP, APRN, PMHNP

Provider Business Mailing Address
First Line	:	900 CY AVE
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-4174
Country	:	US
Telephone Number	:	307-266-1719
Fax Number	:	307-472-7150

Provider Business Practice Location Address
First Line	:	900 CY AVE
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-4174
Country	:	US
Telephone Number	:	307-266-1719
Fax Number	:	307-472-7150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	02/12/2019

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