Healthcare Provider Details

I. General information

NPI: 1356276356
Provider Name (Legal Business Name): NANCY KWAMBOKA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 FIRESTONE LN N
WILSON NC
27896-9130
US

IV. Provider business mailing address

4504 FIRESTONE LN N
WILSON NC
27896-9130
US

V. Phone/Fax

Practice location:
  • Phone: 252-299-6208
  • Fax:
Mailing address:
  • Phone: 252-299-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number313284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: