Provider Demographics
NPI:1568770196
Name:CUEVAS, EDILENE GAYLE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:EDILENE
Middle Name:GAYLE
Last Name:CUEVAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 DARBY DR UNIT 211
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-1750
Mailing Address - Country:US
Mailing Address - Phone:253-376-5055
Mailing Address - Fax:
Practice Address - Street 1:1633 BIRCHWOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-9220
Practice Address - Country:US
Practice Address - Phone:360-715-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60124721172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker