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NPI Code Detail

MEDICARE: CHEYENNE ROSE CLINTON

MEDICARE: CHEYENNE ROSE CLINTON
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
1224Y00000XClinical Exercise Physiologist2003419ND

General Provider Information

NPI Number : 1689505158
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEYENNE ROSE CLINTON
Provider Business Mailing Address
First Line : 1301 15TH AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-3821
Country : US
Telephone Number : 701-774-7090
Fax Number : 701-572-1685
Provider Business Practice Location Address
First Line : 1301 15TH AVE W
Second Line :
City : WILLISTON
State : ND
Zip : 58801-3821
Country : US
Telephone Number : 701-774-7090
Fax Number : 701-572-1685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ CHEYENNE ROSE CLINTON ” Practice Location

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