Provider Demographics
NPI:1295063683
Name:CHEEVER, CHONG H (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHONG
Middle Name:H
Last Name:CHEEVER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-465-3919
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:212 E CENTRAL AVE STE 315
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208
Practice Address - Country:US
Practice Address - Phone:509-465-3919
Practice Address - Fax:509-468-0705
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60082815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908378OtherEMPLOYER MEDICARE
WAGAUP1000OtherEMPLOYER MEDICARE