Provider Demographics
NPI:1245833987
Name:MAHON, CHYENN BROOK
Entity type:Individual
Prefix:
First Name:CHYENN
Middle Name:BROOK
Last Name:MAHON
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 1:29 RUSSELL LESTER DR
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-1409
Mailing Address - Country:US
Mailing Address - Phone:304-785-2422
Mailing Address - Fax:
Practice Address - Street 1:29 RUSSELL LESTER DR
Practice Address - Street 2:
Practice Address - City:DELBARTON
Practice Address - State:WV
Practice Address - Zip Code:25670-1409
Practice Address - Country:US
Practice Address - Phone:304-785-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant