Provider Demographics
NPI:1225881998
Name:ATKINSON, CHEYENNE M
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:M
Last Name:ATKINSON
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 1:2960 KEGONSA DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4824
Mailing Address - Country:US
Mailing Address - Phone:920-650-1096
Mailing Address - Fax:
Practice Address - Street 1:520 HANDEYSIDE LN
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1277
Practice Address - Country:US
Practice Address - Phone:920-563-4372
Practice Address - Fax:920-563-4374
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1161316124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist