Provider Demographics
NPI:1790489029
Name:CUA, JONVIC ROM CASTOR (APRN)
Entity Type:Individual
Prefix:
First Name:JONVIC ROM
Middle Name:CASTOR
Last Name:CUA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BELMONT CT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6501
Mailing Address - Country:US
Mailing Address - Phone:160-386-7880
Mailing Address - Fax:
Practice Address - Street 1:138 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2512
Practice Address - Country:US
Practice Address - Phone:603-663-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH070922-21163W00000X
NH070922-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse