Individual
TANIQUE LEEANNE CUNDIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
33 SEWALL ST, PORTLAND, ME 04102
(207) 828-2100
(207) 828-2190
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7800
(207) 482-7898
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA133016
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8053360
—
NC
Enumeration date
08/17/2008
Last updated
04/09/2019
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