Provider Demographics
NPI:1104636430
Name:MINTER, CHEYENNE ROSE
Entity type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:ROSE
Last Name:MINTER
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 1:6562 STATE ROUTE 220
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-8987
Mailing Address - Country:US
Mailing Address - Phone:513-373-0932
Mailing Address - Fax:
Practice Address - Street 1:6562 STATE ROUTE 220
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-8987
Practice Address - Country:US
Practice Address - Phone:513-373-0932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X, 376J00000X
OHTP324888172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker