Provider Demographics
NPI:1407257074
Name:CUENCA, VIVIANE R (PA-C)
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:R
Last Name:CUENCA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DRIVE
Practice Address - Street 2:7TH FLOOR MED INN
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5845
Practice Address - Country:US
Practice Address - Phone:734-936-9068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-14
Last Update Date:2015-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant