Provider Demographics
NPI:1710610936
Name:CUNNINGHAM, DUSTIN MELVIN
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MELVIN
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 TULIP DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6652
Mailing Address - Country:US
Mailing Address - Phone:307-922-1568
Mailing Address - Fax:
Practice Address - Street 1:1124 TULIP DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6652
Practice Address - Country:US
Practice Address - Phone:307-922-1568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator