Provider Demographics
NPI:1275644817
Name:CUNNINGHAM, JENNIFER (PA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 OGDEN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5894
Mailing Address - Country:US
Mailing Address - Phone:630-375-2852
Mailing Address - Fax:630-375-2838
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-375-2852
Practice Address - Fax:630-375-2838
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant