Provider Demographics
NPI:1275627226
Name:CUNNINGHAM, BONNIE L (APRN,BC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:L
Other - Last Name:MARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN,BC
Mailing Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 210
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4476
Mailing Address - Country:US
Mailing Address - Phone:302-645-3121
Mailing Address - Fax:
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 210
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4476
Practice Address - Country:US
Practice Address - Phone:302-645-3121
Practice Address - Fax:302-645-3428
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELC-0000108364S00000X
DELC 0000108364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
571236Medicare UPIN