Provider Demographics
NPI:1447901095
Name:CHINADLE, CHEYENNE
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:CHINADLE
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 1:15230 ROAD 125 N
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MT
Mailing Address - Zip Code:59528-8611
Mailing Address - Country:US
Mailing Address - Phone:406-231-5758
Mailing Address - Fax:
Practice Address - Street 1:15230 ROAD 125 N
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MT
Practice Address - Zip Code:59528-8611
Practice Address - Country:US
Practice Address - Phone:406-231-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-159771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse