=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407148273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTI CUNNINGHAM CPM, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5880 EASTSIDE CALPELLA RD
-----------------------------------------------------
City | UKIAH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95482-9480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-489-1554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 593
-----------------------------------------------------
City | REDWOOD VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95470-0593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-489-1554
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 265
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------