MEDICARE: CHEYENNE M GASAWAY NP

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.020542	OH

General Provider Information

NPI Number	:	1881133106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE M GASAWAY NP

Provider Business Mailing Address
First Line	:	610 W MAIN ST
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2125
Country	:	US
Telephone Number	:	937-283-9815
Fax Number	:	937-283-9839

Provider Business Practice Location Address
First Line	:	630 W MAIN ST STE 300
Second Line	:
City	:	WILMINGTON
State	:	OH
Zip	:	45177-2172
Country	:	US
Telephone Number	:	937-283-9707
Fax Number	:	937-283-9708

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

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	06/18/2025

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