Provider Demographics
NPI:1811536139
Name:DWEH-CHENNEH, SYREETA
Entity type:Individual
Prefix:MRS
First Name:SYREETA
Middle Name:
Last Name:DWEH-CHENNEH
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 1:512 S HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-7012
Mailing Address - Country:US
Mailing Address - Phone:316-977-8875
Mailing Address - Fax:316-977-8870
Practice Address - Street 1:512 S HORSESHOE BND
Practice Address - Street 2:
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-7012
Practice Address - Country:US
Practice Address - Phone:316-977-8875
Practice Address - Fax:316-977-8870
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility