Individual
MRS. KHANISA CUNNINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRC
Contact information
Practice address
715 KINGSBURY ST, MAUMEE, OH 43537-1823
(937) 219-3394
(866) 203-4192
Mailing address
8569 STONE OAK DR, HOLLAND, OH 43528-8197
(937) 219-3394
(866) 203-4192
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SL171281
OH
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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