Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 5162 | OK |
NPI | 1144494576 |
---|---|
Provider Name | Ms. Jessica Cunningham |
First Address | Edmond, OK 73013-8504 |
Second Address | Edmond, OK 73013-8504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 24/04/2015 |