Provider Demographics
NPI:1548848328
Name:CUNNINGHAM, RICHANNE F (FNP-C)
Entity type:Individual
Prefix:
First Name:RICHANNE
Middle Name:F
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 MOUNT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-9205
Mailing Address - Country:US
Mailing Address - Phone:505-228-3267
Mailing Address - Fax:
Practice Address - Street 1:23745 225TH WAY SE STE 201
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5294
Practice Address - Country:US
Practice Address - Phone:888-674-5871
Practice Address - Fax:206-694-2291
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61152350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily