Provider Demographics
NPI:1114327046
Name:CUNNINGHAM, CARMIN
Entity Type:Individual
Prefix:
First Name:CARMIN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BELLEMONTE ST STE C
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3559
Mailing Address - Country:US
Mailing Address - Phone:937-514-1354
Mailing Address - Fax:
Practice Address - Street 1:10 BELLEMONTE ST STE C
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3559
Practice Address - Country:US
Practice Address - Phone:937-514-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102850Medicaid