Provider Demographics
NPI:1407148273
Name:CUNNINGHAM, KRISTI (CPM, LM)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-0593
Mailing Address - Country:US
Mailing Address - Phone:707-489-1554
Mailing Address - Fax:
Practice Address - Street 1:5880 EASTSIDE CALPELLA RD
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-9480
Practice Address - Country:US
Practice Address - Phone:707-489-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife