Provider Demographics
NPI:1417522608
Name:CUNNINGHAM, MARISSA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-8959
Mailing Address - Country:US
Mailing Address - Phone:724-762-4003
Mailing Address - Fax:
Practice Address - Street 1:107 APACHE DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-8959
Practice Address - Country:US
Practice Address - Phone:724-762-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant