Provider Demographics
NPI:1427562172
Name:FAEH, CHEYENNE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:FAEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:LESKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHLINE DR
Practice Address - Street 2:
Practice Address - City:E WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5341
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60802014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2091914Medicaid