Provider Demographics
NPI:1043066921
Name:CUNNINGHAM, REGINA ANN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
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 1:100 S MAIN ST
Mailing Address - Street 2:AVENUE SUITE 101
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365
Mailing Address - Country:US
Mailing Address - Phone:937-575-7132
Mailing Address - Fax:937-658-6088
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:AVENUE SUITE 101
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365
Practice Address - Country:US
Practice Address - Phone:937-575-7132
Practice Address - Fax:937-658-6088
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant