Provider Demographics
NPI:1922992643
Name:WAYNE, NICOLE CHEYENNE
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:CHEYENNE
Last Name:WAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:WAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:335 E EMERSON AVE APT D
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-5328
Mailing Address - Country:US
Mailing Address - Phone:937-342-6247
Mailing Address - Fax:
Practice Address - Street 1:335 E EMERSON AVE APT D
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-5328
Practice Address - Country:US
Practice Address - Phone:937-342-6247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide