Provider Demographics
NPI:1003951229
Name:HATTEL, DIANE E (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:HATTEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 RAWLINS ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1800
Mailing Address - Country:US
Mailing Address - Phone:307-638-8975
Mailing Address - Fax:307-634-9267
Practice Address - Street 1:3235 SPARKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6151
Practice Address - Country:US
Practice Address - Phone:307-638-8975
Practice Address - Fax:307-634-9267
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16129.0890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00605061OtherRAILROAD MEDICARE - PALMETTO GBA
WY124192300Medicaid
21754Medicare PIN