Provider Demographics
NPI:1851160485
Name:BOBER, CHEYENNE TYLER
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:TYLER
Last Name:BOBER
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 1:40500 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9415
Mailing Address - Country:US
Mailing Address - Phone:440-281-7414
Mailing Address - Fax:
Practice Address - Street 1:40500 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9415
Practice Address - Country:US
Practice Address - Phone:440-281-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide