Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A124884 | IA |
NPI | 1003359308 |
---|---|
Provider Name | Mrs. Christina Marie Cunningham |
First Address | Rock Island, IL 61201-6937 |
Second Address | Bettendorf, IA 52722-6279 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2016 |
Last Update Date | 18/11/2016 |