Provider Demographics
NPI:1851821763
Name:CUNNINGHAM, BRENDA JOYCE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 STRICKLAND LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:77434-7082
Mailing Address - Country:US
Mailing Address - Phone:832-278-3949
Mailing Address - Fax:832-218-2103
Practice Address - Street 1:1798 STRICKLAND LN
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:TX
Practice Address - Zip Code:77434-7082
Practice Address - Country:US
Practice Address - Phone:832-278-3949
Practice Address - Fax:832-218-2103
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty