Provider Demographics
NPI:1134694383
Name:HIPSAK, MICHELLE LEE (DNP, APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:HIPSAK
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4174
Mailing Address - Country:US
Mailing Address - Phone:307-266-1719
Mailing Address - Fax:307-472-7150
Practice Address - Street 1:900 CY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4174
Practice Address - Country:US
Practice Address - Phone:307-266-1719
Practice Address - Fax:307-472-7150
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20480.1809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health