Provider Demographics
NPI:1841078011
Name:CUNNINGHAM, LAAMAR (MSN)
Entity type:Individual
Prefix:
First Name:LAAMAR
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 WOODSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-4203
Mailing Address - Country:US
Mailing Address - Phone:314-493-6430
Mailing Address - Fax:
Practice Address - Street 1:3510 WOODSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-4203
Practice Address - Country:US
Practice Address - Phone:314-493-6430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.448756163WG0000X
MO2011019059163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice