Provider Demographics
NPI:1912070780
Name:CUNEY, MAUREEN TERESA (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:TERESA
Last Name:CUNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 E DUPONT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1545
Mailing Address - Country:US
Mailing Address - Phone:260-373-9700
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:13410 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GRABILL
Practice Address - State:IN
Practice Address - Zip Code:46741-2001
Practice Address - Country:US
Practice Address - Phone:260-969-6600
Practice Address - Fax:260-969-3067
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001634A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000595568OtherANTHEM
IN200326500Medicaid
IN20001107CMedicaid
IN000000659395OtherANTHEM
INP00867126OtherMEDICARE RR
Q45257Medicare UPIN
IN000000659395OtherANTHEM
IN259060WMedicare PIN