Provider Demographics
NPI:1598368904
Name:CUNNINGHAM-TENNYSON, MICHELLE L (CNA PCA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:CUNNINGHAM-TENNYSON
Suffix:
Gender:F
Credentials:CNA PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15593 PARK VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4885
Mailing Address - Country:US
Mailing Address - Phone:734-486-6874
Mailing Address - Fax:
Practice Address - Street 1:15593 PARK VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4885
Practice Address - Country:US
Practice Address - Phone:734-486-6874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000050170376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide