Healthcare Provider Details

I. General information

NPI: 1083006761
Provider Name (Legal Business Name): AMY CUNNINGHAM BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 PURCELL DR. NE
ALBUQUERQUE NM
87111-3757
US

IV. Provider business mailing address

5120 PURCELL DR NE
ALBUQUERQUE NM
87111-3757
US

V. Phone/Fax

Practice location:
  • Phone: 210-844-7464
  • Fax:
Mailing address:
  • Phone: 210-844-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberR44092
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: