Provider Demographics
NPI:1689798795
Name:WILSON, CHEYENNE JODENE (LPN)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:JODENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15452 COUNTY ROAD 274
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-8908
Mailing Address - Country:US
Mailing Address - Phone:740-829-2329
Mailing Address - Fax:740-829-2329
Practice Address - Street 1:15452 COUNTY ROAD 274
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-8908
Practice Address - Country:US
Practice Address - Phone:740-829-2329
Practice Address - Fax:740-829-2329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 131924164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse