Healthcare Provider Details

I. General information

NPI: 1346624582
Provider Name (Legal Business Name): CHERYL CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 S 7650 EAST BOX 9
CROW AGENCY MT
59022-0009
US

IV. Provider business mailing address

37400 RUTLEDGE DR
ZEPHYRHILLS FL
33541-4203
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3500
  • Fax:
Mailing address:
  • Phone: 813-842-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN 3383602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: