Healthcare Provider Details

I. General information

NPI: 1053590034
Provider Name (Legal Business Name): CAROL LYNN W CUNNINGHAM F.N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL LYNN G WYCHICO R.N., P.H.N.

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 ATLANTIC AVE
LONG BEACH CA
90806-2701
US

IV. Provider business mailing address

2701 ATLANTIC AVE
LONG BEACH CA
90806-2701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0249
  • Fax:
Mailing address:
  • Phone: 562-933-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP17602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP17602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: