Provider Demographics
NPI:1932473360
Name:MCCORMACK, SUNNI (MHPP)
Entity Type:Individual
Prefix:
First Name:SUNNI
Middle Name:
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8321
Mailing Address - Country:US
Mailing Address - Phone:501-262-2766
Mailing Address - Fax:501-262-2544
Practice Address - Street 1:2835 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8321
Practice Address - Country:US
Practice Address - Phone:501-262-2766
Practice Address - Fax:501-262-2544
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator