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General NPI Number Information
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NPI Number | 1588473136
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Entity Type | Individual
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Provider Name | STACEY ANN CUNNINGHAM CSFA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 5261 FOUNTAIN DR
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City | CROWN POINT
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State | IN
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Zip | 46307-5322
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Country | US
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Telephone | 219-922-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 9788 W 510 S
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City | WESTPOINT
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State | IN
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Zip | 47992-9352
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Country | US
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Telephone | 765-491-8479
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 119109
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License Number State | IN
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