Healthcare Provider Details

I. General information

NPI: 1174223655
Provider Name (Legal Business Name): STEPHANIE CUNNINGHAM DNP, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. STEPHANIE SEARLE

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PALM AVE
IMPERIAL BEACH CA
91932-1503
US

IV. Provider business mailing address

PO BOX 459
IMPERIAL BEACH CA
91933-0459
US

V. Phone/Fax

Practice location:
  • Phone: 619-429-3733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: