Healthcare Provider Details

I. General information

NPI: 1891334736
Provider Name (Legal Business Name): DONNA JEAN CUDE-ISLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2564 RAMPART TER
RENO NV
89519-8361
US

IV. Provider business mailing address

2564 RAMPART TER
RENO NV
89519-8361
US

V. Phone/Fax

Practice location:
  • Phone: 915-494-1861
  • Fax:
Mailing address:
  • Phone: 915-494-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7078-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: