Basic Information
| Provider Information | |||||||||
| NPI: | 1336501527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMPHREY | ||||||||
| FirstName: | CHEYENNE | ||||||||
| MiddleName: | CYNTHIA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, BSN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 400 | ||||||||
| Address2: | |||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960800400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305276824 | ||||||||
| FaxNumber: | 5305270362 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 WALNUT ST | ||||||||
| Address2: | BUILDING C | ||||||||
| City: | RED BLUFF | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960803611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305276824 | ||||||||
| FaxNumber: | 5305270362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2016 | ||||||||
| LastUpdateDate: | 03/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 831531 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.