Provider Demographics
NPI:1609977172
Name:CUNNINGS, TARA S (DOM, RN)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:S
Last Name:CUNNINGS
Suffix:
Gender:F
Credentials:DOM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SNOW CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5909
Mailing Address - Country:US
Mailing Address - Phone:505-280-2588
Mailing Address - Fax:
Practice Address - Street 1:10200 CORRALES RD NW
Practice Address - Street 2:STE. D 1
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9201
Practice Address - Country:US
Practice Address - Phone:505-897-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR34408163W00000X
CA469214163W00000X
NM876171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered171100000XOther Service ProvidersAcupuncturist