Provider Demographics
NPI:1942235809
Name:CUNNIFF, NELDA NORINE (DO)
Entity Type:Individual
Prefix:DR
First Name:NELDA
Middle Name:NORINE
Last Name:CUNNIFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 RUNNING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-5755
Mailing Address - Country:US
Mailing Address - Phone:817-917-3214
Mailing Address - Fax:
Practice Address - Street 1:780 B NE ALSBURY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-447-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2529204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE2529OtherSTATE LISCENCE
TXE2529OtherSTATE LISCENCE
TX82080JMedicare ID - Type Unspecified