Provider Demographics
NPI:1497267835
Name:CUNNINGHAM, TANYA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JEAN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18428 BLUE HILLS DR SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9316
Mailing Address - Country:US
Mailing Address - Phone:360-894-1525
Mailing Address - Fax:
Practice Address - Street 1:107 1ST ST N
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7718
Practice Address - Country:US
Practice Address - Phone:360-458-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00046332164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse