MEDICARE: MRS. ELIZABETH A. CUNNINGHAM CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	COA.11133-NP	OH
2	363LP0200X	Pediatric Nurse Practitioner	11133-NP	OH

General Provider Information

NPI Number	:	1316252547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH A. CUNNINGHAM CPNP

Provider Business Mailing Address
First Line	:	3300 RIVERSIDE DRIVE, SUITE 200
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-459-4200
Fax Number	:	614-459-1589

Provider Business Practice Location Address
First Line	:	3300 RIVERSIDE DRIVE, SUITE 200
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1738
Country	:	US
Telephone Number	:	614-459-4200
Fax Number	:	614-459-1589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	03/19/2020

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