Healthcare Provider Details
I. General information
NPI: 1336192004
Provider Name (Legal Business Name): JACQUELINE J CUNNING PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/17/2006
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
310 FARM LANE
DOYLESTOWN PA
18904-4732
US
IV. Provider business mailing address
310 FARM LN
DOYLESTOWN PA
18901-4732
US
V. Phone/Fax
- Phone: 215-348-3990
- Fax: 215-348-7705
- Phone: 215-348-3990
- Fax: 215-348-7705
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 364SA2200X |
| Taxonomy | Adult Health Clinical Nurse Specialist |
| License Number | MA050801 |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 0001435061 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PERSCHOICE PERSCHOICE 65 |
| # 2 | |
| Identifier | 21198960001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | KEYSTONE HEALTH PLAN EAST |
| # 3 | |
| Identifier | 21198960001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | KEYSTON HLT PLAN EAST 65 |
| # 4 | |
| Identifier | 4708888939 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST HEALTH CCN |
| # 5 | |
| Identifier | PC0140 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH NET |
| # 6 | |
| Identifier | 0001435061 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PENNSULVANIA BLUE SHIELD |
| # 7 | |
| Identifier | 598899143 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MULTI PLAN |
| # 8 | |
| Identifier | P543147 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | OXFORD |
| # 9 | |
| Identifier | 2119896001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AMERIHEALTH ADMINISTRATOR |
| # 10 | |
| Identifier | 470888939 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | INTERCOUNTY |
| # 11 | |
| Identifier | CK4397 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MEDICARE RAILROAD |
| # 12 | |
| Identifier | 007302 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA HMO |
| # 13 | |
| Identifier | 007302 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA PPO MANAGED CARE |
| # 14 | |
| Identifier | P00044991 |
| Identifier Type | OTHER |
| Identifier State | PA |
| Identifier Issuer | RAILROAD MEDICARE |
| # 15 | |
| Identifier | 1058232 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | KEYSTONE MERCY HEALTH PLA |
| # 16 | |
| Identifier | 2119896001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AMERIHEALTH HMO |
| # 17 | |
| Identifier | 278862 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAMSI |
| # 18 | |
| Identifier | 4708888939 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | DEVON |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
