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General NPI Number Information
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NPI Number | 1508128513
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Entity Type | Individual
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Provider Name | JONATHAN CUETO FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 06/14/2012
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 3795 BUFORD DR
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City | BUFORD
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State | GA
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Zip | 30519-4906
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Country | US
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Telephone | 770-447-9777
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Fax | 770-807-0752
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Provider Business Mailing Address
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Address Line | 3795 BUFORD DR
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City | BUFORD
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State | GA
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Zip | 30519-4906
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Country | US
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Telephone | 770-447-9777
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Fax | 770-807-0752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN203087
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License Number State | GA
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