Provider Demographics
NPI:1790960110
Name:CUNNARD, JACQUELINE N (RN)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:N
Last Name:CUNNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WASHINGTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3335
Mailing Address - Country:US
Mailing Address - Phone:330-722-1069
Mailing Address - Fax:330-764-9712
Practice Address - Street 1:801 E WASHINGTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3335
Practice Address - Country:US
Practice Address - Phone:330-722-1069
Practice Address - Fax:330-764-9712
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.305006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2033454Medicaid