Provider Demographics
NPI:1588453237
Name:CUNNINGHAM, MARY RUTH (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RUTH
Last Name:CUNNINGHAM
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 CRANBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2432
Mailing Address - Country:US
Mailing Address - Phone:217-273-6042
Mailing Address - Fax:
Practice Address - Street 1:4511 CRANBROOK DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2432
Practice Address - Country:US
Practice Address - Phone:217-273-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program