Provider Demographics
NPI:1730195280
Name:IMBROGNO, HANNAH MAE (CFOM)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:MAE
Last Name:IMBROGNO
Suffix:
Gender:F
Credentials:CFOM
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:LEE
Other - Last Name:GIRANY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3001 HENDERSON DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEYANNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:307-638-0900
Mailing Address - Fax:307-638-0908
Practice Address - Street 1:3001 HENDERSON DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHEYANNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-638-0900
Practice Address - Fax:307-638-0908
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCFOM0322224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY314246OtherBC & BS OF WY
4983660001Medicare ID - Type Unspecified