Healthcare Provider Details

I. General information

NPI: 1124837018
Provider Name (Legal Business Name): ELLA KUINOVA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13634 N 93RD AVE STE 300
PEORIA AZ
85381-4915
US

IV. Provider business mailing address

13634 N 93RD AVE STE 300
PEORIA AZ
85381-4915
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-2484
  • Fax: 623-815-2483
Mailing address:
  • Phone: 623-815-2484
  • Fax: 623-815-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236580
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: