Healthcare Provider Details

I. General information

NPI: 1730497561
Provider Name (Legal Business Name): ANNALISA KRISTINE CUNNINGHAM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S GRANGE AVE STE 401
SIOUX FALLS SD
57105-0410
US

IV. Provider business mailing address

3405 6TH ST
BROOKINGS SD
57006-4417
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-8350
  • Fax: 605-333-0245
Mailing address:
  • Phone: 605-693-2230
  • Fax: 605-693-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000621
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: