MEDICARE: MELISSA CUNNINGHAM

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	171400000X	Health & Wellness Coach
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1417781741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CUNNINGHAM

Provider Business Mailing Address
First Line	:	3902 GRAMERCY AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2038
Country	:	US
Telephone Number	:	702-277-6996
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 N DECATUR BLVD STE 116
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3267
Country	:	US
Telephone Number	:	702-685-8776
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	08/29/2024

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Directions to “ MELISSA CUNNINGHAM ” Practice Location

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