Provider Demographics
NPI:1457852808
Name:CUNNINGHAM, ANNALICE GALE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ANNALICE
Middle Name:GALE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3462
Mailing Address - Country:US
Mailing Address - Phone:940-232-6783
Mailing Address - Fax:
Practice Address - Street 1:407 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3462
Practice Address - Country:US
Practice Address - Phone:940-232-6783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232911164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse