Healthcare Provider Details

I. General information

NPI: 1164563680
Provider Name (Legal Business Name): ANN CUEVA RNCFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 BENNETT AVE SUITE B
BURLEY ID
83318-2664
US

IV. Provider business mailing address

1252 BENNETT AVE SUITE B
BURLEY ID
83318-2664
US

V. Phone/Fax

Practice location:
  • Phone: 208-878-3486
  • Fax: 208-878-2005
Mailing address:
  • Phone: 208-878-3486
  • Fax: 208-878-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN10829
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: