Provider Demographics
NPI:1962387738
Name:CERVANTES, EMILLIA MARIE
Entity type:Individual
Prefix:
First Name:EMILLIA
Middle Name:MARIE
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 15TH AVE TRLR 26
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-5153
Mailing Address - Country:US
Mailing Address - Phone:308-440-5239
Mailing Address - Fax:
Practice Address - Street 1:1920 15TH AVE TRLR 26
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-5153
Practice Address - Country:US
Practice Address - Phone:308-440-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion