Healthcare Provider Details

I. General information

NPI: 1962379198
Provider Name (Legal Business Name): AMANDA L CUEVAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 US-89
ALPINE WY
83128
US

IV. Provider business mailing address

PO BOX 2939
ALPINE WY
83128-3902
US

V. Phone/Fax

Practice location:
  • Phone: 760-567-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number46504
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: