Provider Demographics
NPI:1346534187
Name:MCCUNE, HIDIE LYNN (BA)
Entity Type:Individual
Prefix:
First Name:HIDIE
Middle Name:LYNN
Last Name:MCCUNE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:HIDIE
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 LONG DR STE C
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3282
Mailing Address - Country:US
Mailing Address - Phone:307-672-8958
Mailing Address - Fax:307-673-5167
Practice Address - Street 1:1221 W 5TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2701
Practice Address - Country:US
Practice Address - Phone:307-674-5534
Practice Address - Fax:307-673-5167
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator