Individual
CHEYENNE GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
123 N IVY ST, MEDFORD, OR 97501-2723
(541) 326-6892
Mailing address
123 N IVY ST, MEDFORD, OR 97501-2723
(541) 326-6892
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
06/03/2008
Last updated
06/03/2008
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