Individual provider · NPI-1

Kathleen Ann Divincenzo, M.D.

Internal Medicine · Cody, WY

NPI number1477596989
StatusActive
Last updated in NPPESOct 5, 2020

Details

NPI
1477596989
Entity type
Individual (NPI-1)
Name
Kathleen Ann Divincenzo
Credential
M.D.
Sex
Female
Sole proprietor
No
Enumeration date
Jun 13, 2006
Certification date
Oct 5, 2020
Last updated
Oct 5, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine4494AWYYes

Practice location

707 Sheridan Ave
Cody, WY 82414

Phone 307-578-2480 · Fax 307-578-2492

Mailing address

707 Sheridan Ave
Cody, WY 82414

Phone 307-578-2480 · Fax 307-578-2492

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