Healthcare Provider Details

I. General information

NPI: 1699732842
Provider Name (Legal Business Name): EVELYN LEONIE KUIDA R.N. C.O.H.N-S
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. EVELYN LEONIE KUIDA

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 C ST USA YUMA PROVING GROUND HEALTH CLINIC BDG 990
YUMA AZ
85365-9498
US

IV. Provider business mailing address

12234 E CAMINO LOMA VIS
YUMA AZ
85367-7348
US

V. Phone/Fax

Practice location:
  • Phone: 928-328-3206
  • Fax: 928-328-3197
Mailing address:
  • Phone: 928-329-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number235172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: