Healthcare Provider Details

I. General information

NPI: 1194840751
Provider Name (Legal Business Name): BLANCHE ANGELA CUNNINGHAM L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 S 48TH ST
SPRINGDALE AR
72762-6684
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 479-750-7349
  • Fax: 479-750-7354
Mailing address:
  • Phone: 479-750-2020
  • Fax: 479-750-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: