Provider Demographics
NPI:1285466847
Name:CUNNINGHAM, PHILLIP JAMES
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JAMES
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5591 BURNETT DR S
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9238
Mailing Address - Country:US
Mailing Address - Phone:614-406-3722
Mailing Address - Fax:
Practice Address - Street 1:5591 BURNETT DR S
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:OH
Practice Address - Zip Code:43021-9238
Practice Address - Country:US
Practice Address - Phone:614-406-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion