Provider Demographics
NPI:1760591887
Name:CUNNINGHAM, ELIZABETH KENDRICK (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KENDRICK
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SEYMOUR STREET, #204A
Mailing Address - Street 2:HARTFORD HOSPITAL ORTHOPEDICS-BJI PREPARE CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5521
Mailing Address - Country:US
Mailing Address - Phone:860-972-0475
Mailing Address - Fax:
Practice Address - Street 1:31 SEYMOUR ST, 204A
Practice Address - Street 2:HARTFORD HOSPITAL ORTHOPEDICS DEPT-BJI PREPARE CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5521
Practice Address - Country:US
Practice Address - Phone:860-972-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363AM0700X
CT000310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical