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General NPI Number Information
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NPI Number | 1902257280
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Entity Type | Individual
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Provider Name | COLLYN CUNNING
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Gender | Female
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 06/28/2016
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Provider Practice Location Address
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Address Line | 1019 S BROAD ST
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City | LANSDALE
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State | PA
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Zip | 19446-5338
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Country | US
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Telephone | 215-361-5090
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Fax | 215-412-4296
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Provider Business Mailing Address
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Address Line | 1019 S BROAD ST
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City | LANSDALE
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State | PA
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Zip | 19446-5338
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Country | US
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Telephone | 215-361-5090
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Fax | 215-412-4296
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA058224
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License Number State | PA
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