Basic Information
| Provider Information | |||||||||
| NPI: | 1083010318 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUNEO | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6014 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703616014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858734751 | ||||||||
| FaxNumber: | 9858733789 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 CIVIC CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703605937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853332020 | ||||||||
| FaxNumber: | 9858510162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2014 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP07580 | LA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | 04576 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | AP07580 | 05 | LA | MEDICAID |