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General NPI Number Information
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NPI Number | 1265418933
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Entity Type | Individual
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Provider Name | DEBRA CUNNINGHAM CNM, CWHNP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 4 MEMORIAL DR STE 125
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City | ALTON
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State | IL
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Zip | 62002-6704
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Country | US
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Telephone | 618-463-7755
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Fax | 184-336-4206
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Provider Business Mailing Address
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Address Line | 670 MASON RIDGE CENTER DR STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8573
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Country | US
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Telephone | 618-433-6410
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Fax | 618-433-6420
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209005475
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License Number State | IL
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