Organization
WILLOW CREEK FAMILY MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE E HATTEL FNP-C (OWNER)
(307) 638-8975
Entity
Organization
Contact information
Practice address
4003 RAWLINS ST., CHEYENNE, WY 82001-1800
(307) 638-8975
(307) 634-9267
Mailing address
4003 RAWLINS ST, CHEYENNE, WY 82001-1800
(307) 638-8975
(307) 634-9267
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
16129.0890
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125575400
—
WY
01
—
DN1175
RAILROAD MEDICARE - PALMETTO GBA
—
Enumeration date
01/14/2008
Last updated
03/14/2012
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