MEDICARE: ELIZABETH GALE CUEVAS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704146206	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285617035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GALE CUEVAS NP

Provider Business Mailing Address
First Line	:	439 RIVER WOODS DR
Second Line	:
City	:	FLUSHING
State	:	MI
Zip	:	48433-2174
Country	:	US
Telephone Number	:	810-429-3311
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HURLEY PLZ
Second Line	:	9W
City	:	FLINT
State	:	MI
Zip	:	48503-5902
Country	:	US
Telephone Number	:	810-262-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	09/04/2012

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