Provider Demographics
NPI:1053590034
Name:CUNNINGHAM, CAROL LYNN W (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CAROL LYNN
Middle Name:W
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:CAROL LYNN
Other - Middle Name:G
Other - Last Name:WYCHICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:488 E OCEAN BLVD
Mailing Address - Street 2:UNIT # 316
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4761
Mailing Address - Country:US
Mailing Address - Phone:562-624-5862
Mailing Address - Fax:
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:LAC & USC MEDICAL CENTER EMERGENCY MEDICINE RM 1011
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1029
Practice Address - Country:US
Practice Address - Phone:323-226-6667
Practice Address - Fax:323-226-6454
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17602363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily