Provider Demographics
NPI:1457128118
Name:MOORE, CHEYENNE CHAQWANA
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:CHAQWANA
Last Name:MOORE
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 1:1100 CRESCENT DR APT 3
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5500
Mailing Address - Country:US
Mailing Address - Phone:336-587-5196
Mailing Address - Fax:
Practice Address - Street 1:1100 CRESCENT DR APT 3
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5500
Practice Address - Country:US
Practice Address - Phone:336-587-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide