Provider Demographics
NPI:1255403457
Name:WRENN, DIANE MARIE (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:WRENN
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 N HIGLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5906
Mailing Address - Country:US
Mailing Address - Phone:307-324-3723
Mailing Address - Fax:307-370-4070
Practice Address - Street 1:902 N HIGLEY BLVD
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5906
Practice Address - Country:US
Practice Address - Phone:307-324-3723
Practice Address - Fax:307-370-4070
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY23711.08372083X0100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110573001OtherMEDICAID
WY200547740AMedicaid
WY1558082669OtherNPI