Provider Demographics
NPI:1518774918
Name:CUMMINGS, FEARLESS
Entity type:Individual
Prefix:
First Name:FEARLESS
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12328 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1614
Mailing Address - Country:US
Mailing Address - Phone:402-739-7716
Mailing Address - Fax:
Practice Address - Street 1:12328 S 33RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1614
Practice Address - Country:US
Practice Address - Phone:402-739-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251G00000XAgenciesHospice Care, Community Based