Healthcare Provider Details

I. General information

NPI: 1558277749
Provider Name (Legal Business Name): ANNALISA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 BODEGA AVE
PETALUMA CA
94952-8037
US

IV. Provider business mailing address

2645 ELIZABETH CT
SEBASTOPOL CA
95472-2001
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-4340
  • Fax:
Mailing address:
  • Phone: 707-765-4345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number0F0B30ED4B
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: