Provider Demographics
NPI:1902176548
Name:HAMPTON, MICHELE DIANE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JOHN WAYNE LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9469
Mailing Address - Country:US
Mailing Address - Phone:307-754-3105
Mailing Address - Fax:
Practice Address - Street 1:18 JOHN WAYNE LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9469
Practice Address - Country:US
Practice Address - Phone:307-754-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000191966160168OtherKAISER PERMANENTE
CA0019196616OtherKAISER PERMANENTE
CAC4998588OtherDEPARTMENT OF MOTOR VEHICLES