Provider Demographics
NPI:1578865697
Name:CUNNINGHAM, CHRISTINE MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1459
Mailing Address - Country:US
Mailing Address - Phone:518-783-2554
Mailing Address - Fax:518-783-2961
Practice Address - Street 1:515 LOUDON RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1459
Practice Address - Country:US
Practice Address - Phone:518-783-2554
Practice Address - Fax:518-783-2961
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334725-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily