Provider Demographics
NPI:1568423812
Name:CUNNARD, VICKI A (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:A
Last Name:CUNNARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W OTTERMAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2126
Mailing Address - Country:US
Mailing Address - Phone:724-850-6933
Mailing Address - Fax:724-836-6825
Practice Address - Street 1:508 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1702
Practice Address - Country:US
Practice Address - Phone:724-832-4626
Practice Address - Fax:724-836-6825
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006366B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
076851Medicare ID - Type Unspecified
Q09255Medicare UPIN