Healthcare Provider Details

I. General information

NPI: 1255055844
Provider Name (Legal Business Name): CATHERINE CUESTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 GLENWOOD AVE STE 211
RALEIGH NC
27612-3266
US

IV. Provider business mailing address

5171 GLENWOOD AVE STE 211
RALEIGH NC
27612-3266
US

V. Phone/Fax

Practice location:
  • Phone: 910-210-7661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001312992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: