Provider Demographics
NPI:1265418933
Name:CUNNINGHAM, DEBRA (CNM, CWHNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:CNM, CWHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:618-433-6410
Mailing Address - Fax:618-433-6420
Practice Address - Street 1:4 MEMORIAL DR STE 125
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6704
Practice Address - Country:US
Practice Address - Phone:618-463-7755
Practice Address - Fax:184-336-4206
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005475363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26941Medicare PIN