Provider Demographics
NPI:1639431844
Name:SANNE, KATHERINE J (APRN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:SANNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 20TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3882
Mailing Address - Country:US
Mailing Address - Phone:307-633-7444
Mailing Address - Fax:307-996-1595
Practice Address - Street 1:800 E 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3882
Practice Address - Country:US
Practice Address - Phone:307-633-7444
Practice Address - Fax:307-996-1595
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY31824.1241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily