Provider Demographics
NPI:1295626380
Name:TETENMAN, MARC (RN)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:TETENMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-9145
Mailing Address - Country:US
Mailing Address - Phone:307-690-0970
Mailing Address - Fax:
Practice Address - Street 1:5235 HHR RANCH RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9210
Practice Address - Country:US
Practice Address - Phone:307-739-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY37831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse