MEDICARE: MRS. GRETCHEN A CUNNINGHAM CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	4704346345	MI
2	363LA2200X	Adult Health Nurse Practitioner	NP09077	OH
3	363LA2200X	Adult Health Nurse Practitioner	16212	WI

General Provider Information

NPI Number	:	1205951266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETCHEN A CUNNINGHAM CNP

Provider Business Mailing Address
First Line	:	17000 W NORTH AVE STE 200E
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4425
Country	:	US
Telephone Number	:	262-782-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	17000 W NORTH AVE STE 200E
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53005-4425
Country	:	US
Telephone Number	:	262-782-4270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	12/23/2024

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