Provider Demographics
NPI:1073221677
Name:GREENWALT, CHEYENNE SKYE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:SKYE
Last Name:GREENWALT
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 1:3300 SKYLINE BLVD APT 156
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5636
Mailing Address - Country:US
Mailing Address - Phone:775-900-7124
Mailing Address - Fax:
Practice Address - Street 1:1575 DELUCCHI LN STE 218
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8521
Practice Address - Country:US
Practice Address - Phone:775-686-6021
Practice Address - Fax:775-686-6526
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide