Provider Demographics
NPI:1194098715
Name:CUNNINGHAM, MARTHA L (LPN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-1297
Mailing Address - Country:US
Mailing Address - Phone:405-413-5141
Mailing Address - Fax:
Practice Address - Street 1:7924 CHOUTEAU SPGS CIR RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OK
Practice Address - Zip Code:73051-4800
Practice Address - Country:US
Practice Address - Phone:405-413-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter