1841741972 NPI number — MS. CHEYENNE NICOLE RUSSELL BA SOCIOLOGY

Table of content: ALEXIS WALSH (NPI 1942909148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841741972 NPI number — MS. CHEYENNE NICOLE RUSSELL BA SOCIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSSELL
Provider First Name:
CHEYENNE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BA SOCIOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841741972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6765 TULIP FALLS DR
Provider Second Line Business Mailing Address:
UNIT 2056
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89011-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-829-1092
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6655 W SAHARA AVE
Provider Second Line Business Practice Location Address:
STE D110
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89146-0842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-365-0600
Provider Business Practice Location Address Fax Number:
702-365-0602
Provider Enumeration Date:
10/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
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Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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