Provider Demographics
NPI:1710118161
Name:CUNNINGHAM, LATASHA L (NP)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:L
Last Name:CUNNINGHAM
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 1:107 PIPER HILL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1651
Mailing Address - Country:US
Mailing Address - Phone:402-770-7562
Mailing Address - Fax:
Practice Address - Street 1:107 PIPER HILL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1651
Practice Address - Country:US
Practice Address - Phone:314-477-8757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009022057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily