Provider Demographics
NPI:1619248770
Name:CUNNINGHAM, MARIAN CLARA (LMP, HHP)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:CLARA
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMP, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 W BAKERVIEW RD
Mailing Address - Street 2:SUITE 105-204
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8176
Mailing Address - Country:US
Mailing Address - Phone:360-483-6192
Mailing Address - Fax:
Practice Address - Street 1:424 W BAKERVIEW RD
Practice Address - Street 2:SUITE 105-204
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8176
Practice Address - Country:US
Practice Address - Phone:360-483-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60202261172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker