Healthcare Provider Details

I. General information

NPI: 1972495190
Provider Name (Legal Business Name): STEPHANIE F CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

IV. Provider business mailing address

69282 HIGHWAY 59 STE 4
MANDEVILLE LA
70471-7676
US

V. Phone/Fax

Practice location:
  • Phone: 985-951-2020
  • Fax: 985-951-2025
Mailing address:
  • Phone: 985-951-2020
  • Fax: 985-951-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN100917
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: