Provider Demographics
NPI:1932535465
Name:WIMMLER, DANIELLE LYNN (MED)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LYNN
Last Name:WIMMLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WERNER CT STE 300
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1325
Mailing Address - Country:US
Mailing Address - Phone:307-333-3998
Mailing Address - Fax:
Practice Address - Street 1:800 WERNER CT STE 300
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1325
Practice Address - Country:US
Practice Address - Phone:307-224-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WYLPC-1499101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY136144901Medicaid