Provider Demographics
NPI:1740929793
Name:CUNNINGHAM, TIFFANY (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 HIDDEN KNOLLS CT
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3419
Mailing Address - Country:US
Mailing Address - Phone:937-673-1400
Mailing Address - Fax:
Practice Address - Street 1:513 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4112
Practice Address - Country:US
Practice Address - Phone:937-350-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN497030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE