1184145492 NPI number — MS. SHANA CHRISTIAN CUNNINGHAM MSN, RN, BC-ADM, CDE

Table of content: MS. SHANA CHRISTIAN CUNNINGHAM MSN, RN, BC-ADM, CDE (NPI 1184145492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184145492 NPI number — MS. SHANA CHRISTIAN CUNNINGHAM MSN, RN, BC-ADM, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
SHANA
Provider Middle Name:
CHRISTIAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, BC-ADM, CDE
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:
1184145492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 SOUTH LIMESTONE, UNIVERSITY HEALTH SERVICES BLDG
Provider Second Line Business Mailing Address:
BARNESSTABLE BROWN DIABETES CENTER, 4TH FLOOR
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-5407
Provider Business Mailing Address Fax Number:
859-257-0487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2195 HARRODSBURG RD STE 125
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-2232
Provider Business Practice Location Address Fax Number:
859-257-0659
Provider Enumeration Date:
06/28/2017

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: 163W00000X , with the licence number:  1105645 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WD0400X , with the licence number: 129960 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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