Provider Demographics
NPI:1538039490
Name:CUNNINGHAM, MATTIE (RN)
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 CEDAR COVE RD APT 826
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-7872
Mailing Address - Country:US
Mailing Address - Phone:402-875-7362
Mailing Address - Fax:
Practice Address - Street 1:8207 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2093
Practice Address - Country:US
Practice Address - Phone:402-484-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE91695163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator