Provider Demographics
NPI:1689965840
Name:CUA, NENITA A (MD)
Entity Type:Individual
Prefix:MISS
First Name:NENITA
Middle Name:A
Last Name:CUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 N. MARINE DRIVE, APT. 3D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3259
Mailing Address - Country:US
Mailing Address - Phone:773-561-9714
Mailing Address - Fax:
Practice Address - Street 1:5100 N. MARINE DRIVE UNIT 3D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3259
Practice Address - Country:US
Practice Address - Phone:773-561-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-056950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics