Healthcare Provider Details

I. General information

NPI: 1083010318
Provider Name (Legal Business Name): ROSE CUNEO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

IV. Provider business mailing address

PO BOX 6014
HOUMA LA
70361-6014
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-2020
  • Fax: 985-851-0452
Mailing address:
  • Phone: 985-873-4751
  • Fax: 985-873-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP07580
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number04576
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: