1578990917 NPI number — LAURA MICHELLE CUNNINGHAM FNP-BC

Table of content: LAURA MICHELLE CUNNINGHAM FNP-BC (NPI 1578990917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578990917 NPI number — LAURA MICHELLE CUNNINGHAM FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
LAURA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CUNNINGHAM
Provider Other First Name:
LAURA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578990917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 MACCORKLE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-5590
Provider Business Mailing Address Fax Number:
304-388-8238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 DONNALLY ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25301-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-342-0124
Provider Business Practice Location Address Fax Number:
304-340-2204
Provider Enumeration Date:
09/30/2013

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: 363LF0000X , with the licence number:  APRN60126NP , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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