Provider Demographics
NPI:1265456545
Name:CUNNINGHAM, VIVIAN M (NP)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 STATE RT. 38
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021
Mailing Address - Country:US
Mailing Address - Phone:315-253-8477
Mailing Address - Fax:315-255-0757
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3503
Practice Address - Country:US
Practice Address - Phone:315-253-8477
Practice Address - Fax:315-255-0757
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330110-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily