Healthcare Provider Details

I. General information

NPI: 1275577330
Provider Name (Legal Business Name): RHONDA L CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 E MAIN ST
FREMONT MI
49412-1243
US

IV. Provider business mailing address

1675 LEAHY ST STE 109
MUSKEGON MI
49442-5500
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-7944
  • Fax: 231-924-7943
Mailing address:
  • Phone: 231-728-5720
  • Fax: 231-728-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3501004378
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: