Provider Demographics
NPI:1275264160
Name:WIMBELY, CHEYENNE JENAE (STNA)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:JENAE
Last Name:WIMBELY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RHODES AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1434
Mailing Address - Country:US
Mailing Address - Phone:234-200-9867
Mailing Address - Fax:
Practice Address - Street 1:16 RHODES AVE APT 22
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1434
Practice Address - Country:US
Practice Address - Phone:234-200-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH601272220422364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health