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General NPI Number Information
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NPI Number | 1073640371
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Entity Type | Individual
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Provider Name | JUDY CUNNINGHAM
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 43740 N GROESBECK HWY
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1139
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Country | US
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Telephone | 586-469-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 13752 TIMBERVIEW DR
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-2060
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704161562
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 4704161562
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 4704161562
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 4704161562
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License Number State | MI
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