Individual
TAMMY L CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
Mailing address
110 ROANE ST, CHARLESTON, WV 25302-2334
(304) 344-0096
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
35349
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720704
MSBCBS
WV
05
—
0068838000
—
WV
01
—
1071159
WORKERS COMP INDIVIDUAL
WV
Enumeration date
07/17/2006
Last updated
10/03/2013
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