Provider Demographics
NPI:1730497561
Name:CUNNINGHAM, ANNALISA KRISTINE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNALISA
Middle Name:KRISTINE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4417
Mailing Address - Country:US
Mailing Address - Phone:605-693-2230
Mailing Address - Fax:605-693-2237
Practice Address - Street 1:1205 S GRANGE AVE STE 401
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0410
Practice Address - Country:US
Practice Address - Phone:605-312-8350
Practice Address - Fax:605-333-0245
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily