Provider Demographics
NPI:1760550719
Name:CUNDY, CHARLYNN MARIE (RN, NP)
Entity Type:Individual
Prefix:
First Name:CHARLYNN
Middle Name:MARIE
Last Name:CUNDY
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:CHARLYNN
Other - Middle Name:MARIE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10725 INTERNATIONAL DR
Mailing Address - Street 2:KAISER PERMANENTE WOMEN'S HEALTH
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7967
Mailing Address - Country:US
Mailing Address - Phone:916-631-3080
Mailing Address - Fax:916-631-2209
Practice Address - Street 1:10725 INTERNATIONAL DR
Practice Address - Street 2:KAISER PERMANENTE WOMEN'S HEALTH
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-7967
Practice Address - Country:US
Practice Address - Phone:916-631-3080
Practice Address - Fax:916-631-2209
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN500836, NP13238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN500836Medicaid
CAZZZ02898ZMedicare ID - Type UnspecifiedPROVIDER ID NUMBER
CARN500836Medicaid