Provider Demographics
NPI:1760650188
Name:CUKA, ADELIA MAE (CNS,RN,MSN)
Entity type:Individual
Prefix:MRS
First Name:ADELIA
Middle Name:MAE
Last Name:CUKA
Suffix:
Gender:F
Credentials:CNS,RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WASHINGTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-4300
Mailing Address - Country:US
Mailing Address - Phone:605-384-3621
Mailing Address - Fax:605-384-3293
Practice Address - Street 1:111 WASHINGTON AVE NW
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-4300
Practice Address - Country:US
Practice Address - Phone:605-384-3621
Practice Address - Fax:605-384-3293
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCS004117364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5540100Medicaid
SD5540030Medicaid