Provider Demographics
NPI:1316413677
Name:CUNNINGHAM, SHANNON KATHLEEN (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2748
Mailing Address - Country:US
Mailing Address - Phone:531-299-2080
Mailing Address - Fax:531-299-2089
Practice Address - Street 1:4304 N 33RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2748
Practice Address - Country:US
Practice Address - Phone:531-299-2080
Practice Address - Fax:531-299-2089
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64105163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool