Provider Demographics
NPI:1285016378
Name:CUNNINGHAM, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
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 1:2663 SUMMERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9511
Mailing Address - Country:US
Mailing Address - Phone:734-279-2595
Mailing Address - Fax:
Practice Address - Street 1:2663 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:MI
Practice Address - Zip Code:49270-9511
Practice Address - Country:US
Practice Address - Phone:734-279-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other