Healthcare Provider Details

I. General information

NPI: 1013351196
Provider Name (Legal Business Name): KRYSTEL V CUNNINGFOLK LM, CPM, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 11/18/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 1/2 FOLSOM BLVD
SACRAMENTO CA
95816-5262
US

IV. Provider business mailing address

3269 1/2 FOLSOM BLVD
SACRAMENTO CA
95816-5262
US

V. Phone/Fax

Practice location:
  • Phone: 916-426-8456
  • Fax: 916-245-6156
Mailing address:
  • Phone: 916-426-8456
  • Fax: 916-245-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: