Provider Demographics
NPI:1184601700
Name:MATTERN, DIANE KENTON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:KENTON
Last Name:MATTERN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:SENTINELLA
Other - Last Name:MATTERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3243 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-5307
Mailing Address - Country:US
Mailing Address - Phone:307-259-1388
Mailing Address - Fax:
Practice Address - Street 1:475 SOUTH SPRUCE
Practice Address - Street 2:CASPER NATRONA COUNTY HEALTH DEPARTMENT
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-0000
Practice Address - Country:US
Practice Address - Phone:307-235-9340
Practice Address - Fax:307-237-2036
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10883.122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health