MEDICARE: SHATERICA 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	164W00000X	Licensed Practical Nurse	4703116380	MI

General Provider Information

NPI Number	:	1609238799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATERICA CUNNINGHAM

Provider Business Mailing Address
First Line	:	19190 WESTBROOK ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1942
Country	:	US
Telephone Number	:	313-740-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	19190 WESTBROOK ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-1942
Country	:	US
Telephone Number	:	313-740-1359
Fax Number	:

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/28/2016

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Directions to “ SHATERICA CUNNINGHAM ” Practice Location

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