Healthcare Provider Details

I. General information

NPI: 1760307227
Provider Name (Legal Business Name): TERIANA NICOLE CUELLAR APRN, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE APT 2411
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

4234 S ELLIS AVE UNIT 4B
CHICAGO IL
60653-3015
US

V. Phone/Fax

Practice location:
  • Phone: 602-419-8218
  • Fax:
Mailing address:
  • Phone: 602-419-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209.034570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: