MEDICARE: CHEYENNE ROSANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1376188904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE ROSANDER

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	NORTH BONNEVILLE
State	:	WA
Zip	:	98639-0218
Country	:	US
Telephone Number	:	509-281-0558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1113 WACOMAC ST
Second Line	:
City	:	NORTH BONNEVILLE
State	:	WA
Zip	:	98639-4650
Country	:	US
Telephone Number	:	509-281-0558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ CHEYENNE ROSANDER ” Practice Location

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