Provider Demographics
NPI:1700359148
Name:DACUYCUY, KRISTEN MARIE QUEJA (FNP, RN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN MARIE
Middle Name:QUEJA
Last Name:DACUYCUY
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 MAGANDA AVE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-4758
Mailing Address - Country:US
Mailing Address - Phone:661-229-9568
Mailing Address - Fax:
Practice Address - Street 1:2027 MAGANDA AVE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-4758
Practice Address - Country:US
Practice Address - Phone:661-229-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily