Provider Demographics
NPI:1790650521
Name:CUNNINGHAM, BREANNA NICOLE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICOLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-1445
Mailing Address - Country:US
Mailing Address - Phone:951-355-4719
Mailing Address - Fax:
Practice Address - Street 1:3744 WHITE OAK DR
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-1445
Practice Address - Country:US
Practice Address - Phone:951-355-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program