Provider Demographics
NPI:1336501527
Name:O'SULLIVAN, CHEYENNE CYNTHIA (RN, BSN, PHN)
Entity Type:Individual
Prefix:MISS
First Name:CHEYENNE
Middle Name:CYNTHIA
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-3457
Mailing Address - Country:US
Mailing Address - Phone:530-233-6311
Mailing Address - Fax:530-233-6332
Practice Address - Street 1:441 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-3457
Practice Address - Country:US
Practice Address - Phone:530-233-6311
Practice Address - Fax:530-233-6332
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA831531163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse