Individual
JESSICA JEAN CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, LPN
Contact information
Practice address
30286 FOX RUN RD, STACY, MN 55079-9653
(651) 269-3362
Mailing address
30286 FOX RUN RD, STACY, MN 55079-9653
(651) 269-3362
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R 199450-0
MN
164W00000X
Licensed Practical Nurse
L 067912-7
MN
Other
Enumeration date
02/10/2011
Last updated
02/10/2011
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