Provider Demographics
NPI:1104999747
Name:HART, ANN MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4011
Mailing Address - Country:US
Mailing Address - Phone:307-745-4460
Mailing Address - Fax:
Practice Address - Street 1:501 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4011
Practice Address - Country:US
Practice Address - Phone:307-460-8570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17320.174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112888400Medicaid
WYS43403Medicare UPIN
WY20598Medicare ID - Type Unspecified