Provider Demographics
NPI:1033797998
Name:CUNNINGHAM, NAWON SHERNICE (RN)
Entity Type:Individual
Prefix:
First Name:NAWON
Middle Name:SHERNICE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N NEW BALLAS RD UNIT 410468
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5521
Mailing Address - Country:US
Mailing Address - Phone:972-786-6882
Mailing Address - Fax:
Practice Address - Street 1:7320 FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-2526
Practice Address - Country:US
Practice Address - Phone:972-786-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse