Healthcare Provider Details

I. General information

NPI: 1033020706
Provider Name (Legal Business Name): MARSHALA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE 10TH ST
MOORE OK
73160-8554
US

IV. Provider business mailing address

2200 NE 10TH ST
MOORE OK
73160-8554
US

V. Phone/Fax

Practice location:
  • Phone: 469-544-1206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: