Healthcare Provider Details

I. General information

NPI: 1770525818
Provider Name (Legal Business Name): SHELLEY CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SUNSET AVE
MANHATTAN KS
66502-3761
US

IV. Provider business mailing address

1105 SUNSET AVE
MANHATTAN KS
66502-3761
US

V. Phone/Fax

Practice location:
  • Phone: 785-532-7755
  • Fax: 785-532-6627
Mailing address:
  • Phone: 785-532-7755
  • Fax: 785-532-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number1348990092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: