Provider Demographics
NPI:1447278007
Name:CUNNINGHAM, SARA RENE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:RENE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:1418 S MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3543
Mailing Address - Country:US
Mailing Address - Phone:785-242-1620
Mailing Address - Fax:785-242-3825
Practice Address - Street 1:1418 S MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3543
Practice Address - Country:US
Practice Address - Phone:785-242-1620
Practice Address - Fax:785-242-3825
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS45826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161626OtherBLUE CROSS BLUE SHIELD