Provider Demographics
NPI:1962560029
Name:CUNNINGHAM, NINA (LAC)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:NINA
Other - Middle Name:ALLEN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:518 SOUTH AUBURN STREET
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-273-0098
Mailing Address - Fax:530-273-0098
Practice Address - Street 1:518 SOUTH AUBURN STREET
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-273-0098
Practice Address - Fax:530-273-0098
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2442171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist