Individual
GLEN MARTIN CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2400 SW VERMONT ST, PORTLAND, OR 97219-1940
(503) 452-0915
Mailing address
PO BOX 27, SUBLIMITY, OR 97385-0027
(541) 602-0047
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10055208
OR
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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