Provider Demographics
NPI:1811687890
Name:MOUNTAIN MEDICINE INTEGRATIVE WELLNESS
Entity type:Organization
Organization Name:MOUNTAIN MEDICINE INTEGRATIVE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-220-9409
Mailing Address - Street 1:569 PEAVINE FIRETOWER RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-0997
Mailing Address - Country:US
Mailing Address - Phone:931-710-5483
Mailing Address - Fax:931-810-9272
Practice Address - Street 1:58 W FIRST ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4443
Practice Address - Country:US
Practice Address - Phone:931-710-5483
Practice Address - Fax:931-810-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty