Provider Demographics
NPI:1407603574
Name:CUNNINGHAM, JESSICA NICOLE (RWP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RWP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 SHADOW WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-9121
Mailing Address - Country:US
Mailing Address - Phone:614-668-5881
Mailing Address - Fax:
Practice Address - Street 1:11135 SHADOW WOODS LN
Practice Address - Street 2:
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9121
Practice Address - Country:US
Practice Address - Phone:614-668-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist