Provider Demographics
NPI:1821607219
Name:CUNDIFF, ALENA VLADIMIROVNA
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:VLADIMIROVNA
Last Name:CUNDIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4471
Mailing Address - Country:US
Mailing Address - Phone:432-254-1757
Mailing Address - Fax:
Practice Address - Street 1:7321 SOUTHERN BELLE CIR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1550
Practice Address - Country:US
Practice Address - Phone:432-222-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily