Provider Demographics
NPI:1912736703
Name:CUNNINGHAM, JAZMIN JENAE
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:JENAE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:JENAE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24570 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-4121
Mailing Address - Country:US
Mailing Address - Phone:909-644-5009
Mailing Address - Fax:
Practice Address - Street 1:24570 JASMINE CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-4121
Practice Address - Country:US
Practice Address - Phone:909-644-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95213613163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics