Healthcare Provider Details

I. General information

NPI: 1053052654
Provider Name (Legal Business Name): CHEYENNE ELAINE HURD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MISSION ST STE 102
WENATCHEE WA
98801-6612
US

IV. Provider business mailing address

610 N MISSION ST STE 102
WENATCHEE WA
98801-6612
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-4711
  • Fax: 509-662-2800
Mailing address:
  • Phone: 509-662-4711
  • Fax: 509-662-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61227699
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: