Provider Demographics
NPI:1134602683
Name:EDMONSON, CHEYENNE ROSE (EDMOCH)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:ROSE
Last Name:EDMONSON
Suffix:
Gender:F
Credentials:EDMOCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 E 33RD PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-1206
Mailing Address - Country:US
Mailing Address - Phone:303-962-2270
Mailing Address - Fax:303-962-2280
Practice Address - Street 1:14500 E 33RD PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-1206
Practice Address - Country:US
Practice Address - Phone:303-962-2270
Practice Address - Fax:303-962-2280
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist