Provider Demographics
NPI:1386159531
Name:CUNNINGHAM, MARSHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LYNCH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1818
Mailing Address - Country:US
Mailing Address - Phone:314-535-5600
Mailing Address - Fax:314-615-2140
Practice Address - Street 1:1001 LYNCH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1818
Practice Address - Country:US
Practice Address - Phone:314-535-5600
Practice Address - Fax:314-615-2140
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016950363LP0808X
MO2017002706363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health