Provider Demographics
NPI:1063006492
Name:CUAUXINQUE, MIKAELA DANIELLE SYMONS
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:DANIELLE SYMONS
Last Name:CUAUXINQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKAELA
Other - Middle Name:DANIELLE
Other - Last Name:SYMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20260 SE CHERRY BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:OR
Mailing Address - Zip Code:97101-2402
Mailing Address - Country:US
Mailing Address - Phone:971-241-9225
Mailing Address - Fax:
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3923
Practice Address - Country:US
Practice Address - Phone:503-434-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator