Healthcare Provider Details

I. General information

NPI: 1962560029
Provider Name (Legal Business Name): NINA CUNNINGHAM LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NINA ALLEN CUNNINGHAM

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 SOUTH AUBURN STREET
GRASS VALLEY CA
95945
US

IV. Provider business mailing address

518 SOUTH AUBURN STREET
GRASS VALLEY CA
95945
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-0098
  • Fax: 530-273-0098
Mailing address:
  • Phone: 530-273-0098
  • Fax: 530-273-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC2442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: