Provider Demographics
NPI:1205253754
Name:CUNNINGHAM, LILLIAN (ND)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 KA DR
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8507
Mailing Address - Country:US
Mailing Address - Phone:808-276-2875
Mailing Address - Fax:
Practice Address - Street 1:123 KA DR
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8507
Practice Address - Country:US
Practice Address - Phone:808-276-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIND-97175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath