Healthcare Provider Details

I. General information

NPI: 1811789308
Provider Name (Legal Business Name): JAMIE CUNNINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S TRIMBLE RD
MANSFIELD OH
44906-3427
US

IV. Provider business mailing address

6361 LIVIA LN
MEDINA OH
44256-7765
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-4602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number405284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: