Doctor Name: | MR. BRIAN R CUNNINGHAM |
NPI Number: | 1366799934 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PMHNP-BC |
License Number: | AP60301512 |
Business Practice Address: | 982 Chambers St South Ogden, UT - 844034571 |
Business Phone Number: | 8015821565 |
Business Fax Number: | |
Mailing Address: | 982 Chambers St, SOUTH OGDEN |
State: | UT |
Postal Code: | 844034571 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/13/2012 |
NPI Last Update Date: | 06/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | AP60301512 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |