Provider Demographics
NPI:1386827780
Name:CUNNINGHAM, JENNIFER ELLEN (APRN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:164 SUMMIT AVE
Mailing Address - Street 2:FAIN BUILDING 3RD FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2853
Mailing Address - Country:US
Mailing Address - Phone:401-793-2920
Mailing Address - Fax:401-793-2859
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:FAIN BUILDING 3RD FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-793-2920
Practice Address - Fax:401-793-2859
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2015-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT003658363LA2200X
RINPP37511363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health