Provider Demographics
NPI:1013351196
Name:CUNNINGFOLK, KRYSTEL V (LM, CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:V
Last Name:CUNNINGFOLK
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3269 1/2 FOLSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5262
Mailing Address - Country:US
Mailing Address - Phone:916-426-8456
Mailing Address - Fax:916-245-6156
Practice Address - Street 1:3269 1/2 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5262
Practice Address - Country:US
Practice Address - Phone:916-426-8456
Practice Address - Fax:916-245-6156
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife