Healthcare Provider Details

I. General information

NPI: 1548595895
Provider Name (Legal Business Name): CATHERINE LYNN CUNNINGHAM CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE SUITE 200
TULSA OK
74104-5649
US

IV. Provider business mailing address

1515 N HARVARD AVE SUITE E
TULSA OK
74115-4957
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7854
  • Fax: 918-293-3116
Mailing address:
  • Phone: 918-832-6049
  • Fax: 918-832-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR0069694
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: