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WILLOW CREEK FAMILY MEDICINE P.C. NPI 1184800674


NPI Information

NPI: 1184800674
Provider Name: WILLOW CREEK FAMILY MEDICINE, P.C.
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 53D1080142

Address:
4003 RAWLINS ST.
CHEYENNE, WY
ZIP 82001
Phone: (307) 638-8975
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WILLOW CREEK FAMILY MEDICINE, P.C. is a family nurse practitioner in Cheyenne, WY. WILLOW CREEK FAMILY MEDICINE, P.C. NPI is 1184800674. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4003 RAWLINS ST.
CHEYENNE, WY
ZIP 82001-800
Phone: (307) 638-8975
Fax: (307) 634-9267

The provider's authorized official is Diane E Hattel .
The authorized official title is Owner and has the following contact phone number (307) 638-8975.

The CLIA number assigned to this NPI record is 53D1080142 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/14/2008 and was last updated on 3/14/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363LF0000XNurse PractitionerFamily16129.0890WYOMINGYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
121772MEDICARE PIN
2125575400MEDICAIDWYOMING
3DN1175OTHERRAILROAD MEDICARE - PALMETTO GBA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.