Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | CH8756 | FL |
Y | 111NN1001X | Nutrition | CHIA-1428 | ID |
NPI | 1306058789 |
---|---|
Provider Name | Dr. Wendy Nagy Cunningham |
First Address | Hayden, ID 83835-8231 |
Second Address | Hayden, ID 83835-8231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2007 |
Last Update Date | 08/12/2010 |