Provider Demographics
NPI:1326424904
Name:CUNNINGHAM, LAURA L (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WESTOWN PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1315
Mailing Address - Country:US
Mailing Address - Phone:515-227-6065
Mailing Address - Fax:833-907-2405
Practice Address - Street 1:1441 29TH ST STE 211
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1309
Practice Address - Country:US
Practice Address - Phone:515-227-6065
Practice Address - Fax:833-907-2405
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA233710100Medicare PIN