Provider Demographics
NPI:1588999759
Name:HARTMAN, KATY MARIE (MD)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:MARIE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E SHERIDAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3868
Mailing Address - Country:US
Mailing Address - Phone:307-460-9039
Mailing Address - Fax:307-460-9041
Practice Address - Street 1:920 E SHERIDAN ST STE A
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3868
Practice Address - Country:US
Practice Address - Phone:307-460-9039
Practice Address - Fax:307-460-9041
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8319A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine