1265418933 NPI number — DEBRA CUNNINGHAM CNM, CWHNP

Table of content: DEBRA CUNNINGHAM CNM, CWHNP (NPI 1265418933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265418933 NPI number — DEBRA CUNNINGHAM CNM, CWHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
DEBRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM, CWHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265418933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 MASON RIDGE CENTER DR
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63141-8573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-433-6410
Provider Business Mailing Address Fax Number:
618-433-6420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 MEMORIAL DR STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62002-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-463-7755
Provider Business Practice Location Address Fax Number:
184-336-4206
Provider Enumeration Date:
12/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  209005475 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)