Healthcare Provider Details

I. General information

NPI: 1447247713
Provider Name (Legal Business Name): PEGGY L CUVALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N 8TH ST
ST MARIES ID
83861-1845
US

IV. Provider business mailing address

PO BOX 146
ST MARIES ID
83861-0146
US

V. Phone/Fax

Practice location:
  • Phone: 208-245-4556
  • Fax: 208-245-3692
Mailing address:
  • Phone: 208-245-4556
  • Fax: 208-245-3692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP366A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP366A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: