Healthcare Provider Details

I. General information

NPI: 1992131650
Provider Name (Legal Business Name): SARA E CUNNINGHAM R.T. (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 E LINWOOD BLVD
KANSAS CITY MO
64128-2226
US

IV. Provider business mailing address

19400 E 37TH TERRACE CT S APT 617
INDEPENDENCE MO
64057-2484
US

V. Phone/Fax

Practice location:
  • Phone: 816-861-4700
  • Fax:
Mailing address:
  • Phone: 785-769-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number510730
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: