Provider Demographics
NPI:1023258670
Name:CHEYENNE HISTOLOGY
Entity type:Organization
Organization Name:CHEYENNE HISTOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAFANG
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-459-4169
Mailing Address - Street 1:1414 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5119
Mailing Address - Country:US
Mailing Address - Phone:307-459-4169
Mailing Address - Fax:
Practice Address - Street 1:1414 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5119
Practice Address - Country:US
Practice Address - Phone:307-459-4169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RH0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyHistologyGroup - Single Specialty