Provider Demographics
NPI:1164423810
Name:CUNNINGHAM, DONNA (APRN,BC,FNP)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN,BC,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-8756
Mailing Address - Country:US
Mailing Address - Phone:937-383-3870
Mailing Address - Fax:937-383-9875
Practice Address - Street 1:4439 STATE RT 159
Practice Address - Street 2:SUITE 260
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601
Practice Address - Country:US
Practice Address - Phone:740-779-7460
Practice Address - Fax:740-779-7463
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-266732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2314945Medicaid
OH2314945Medicaid
OHP60283Medicare UPIN