Provider Demographics
NPI:1366072332
Name:WARNER, CHEYENNE PRETTYFLOWER
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:PRETTYFLOWER
Last Name:WARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SW 23RD PL
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7125
Mailing Address - Country:US
Mailing Address - Phone:580-665-8688
Mailing Address - Fax:
Practice Address - Street 1:203 SW 23RD PL
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7125
Practice Address - Country:US
Practice Address - Phone:580-665-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist