Healthcare Provider Details

I. General information

NPI: 1497265169
Provider Name (Legal Business Name): ELIZABETH CUNNINGHAM DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 AVALON BLVD
LOS ANGELES CA
90011-5622
US

IV. Provider business mailing address

5805 CARTWRIGHT AVE
NORTH HOLLYWOOD CA
91601-1402
US

V. Phone/Fax

Practice location:
  • Phone: 865-804-4903
  • Fax:
Mailing address:
  • Phone: 865-804-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95006863
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95104240
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number196846
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: