Provider Demographics
NPI:1124795414
Name:DONALDSON, CHEYANNA (LMT, NTS)
Entity type:Individual
Prefix:
First Name:CHEYANNA
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:LMT, NTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PRAIRIE RD NE APT 1307
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1973
Mailing Address - Country:US
Mailing Address - Phone:505-270-4394
Mailing Address - Fax:
Practice Address - Street 1:6800 PRAIRIE RD NE APT 1307
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1973
Practice Address - Country:US
Practice Address - Phone:505-270-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8384173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist