Healthcare Provider Details

I. General information

NPI: 1568423812
Provider Name (Legal Business Name): VICKI A CUNNARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S CHURCH ST
MT PLEASANT PA
15666-1702
US

IV. Provider business mailing address

501 W OTTERMAN ST SUITE B
GREENSBURG PA
15601-2126
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4626
  • Fax: 724-836-6825
Mailing address:
  • Phone: 724-850-6933
  • Fax: 724-836-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP006366B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: