Provider Demographics
NPI:1598096471
Name:CUNICO, LOLA (RN, CDE,BS)
Entity Type:Individual
Prefix:
First Name:LOLA
Middle Name:
Last Name:CUNICO
Suffix:
Gender:F
Credentials:RN, CDE,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2917
Mailing Address - Country:US
Mailing Address - Phone:575-541-4451
Mailing Address - Fax:575-524-1454
Practice Address - Street 1:1100 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2917
Practice Address - Country:US
Practice Address - Phone:575-541-4451
Practice Address - Fax:575-524-1454
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
NMR34994163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist