Healthcare Provider Details

I. General information

NPI: 1588468987
Provider Name (Legal Business Name): CHEYENNE WHEELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 3RD ST
LINCOLN CA
95648-1562
US

IV. Provider business mailing address

406 SUNRISE AVE STE 100
ROSEVILLE CA
95661-4106
US

V. Phone/Fax

Practice location:
  • Phone: 530-536-9508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-XTPLYN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: