Provider Demographics
NPI:1750026902
Name:CUNNINGHAM, JAYLENE M (RN)
Entity Type:Individual
Prefix:
First Name:JAYLENE
Middle Name:M
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JAYLENE
Other - Middle Name:M
Other - Last Name:WOODARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 E C ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2844
Mailing Address - Country:US
Mailing Address - Phone:307-575-5897
Mailing Address - Fax:
Practice Address - Street 1:2010 E C ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-2844
Practice Address - Country:US
Practice Address - Phone:307-575-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY30251163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator