Provider Demographics
NPI:1003672775
Name:BRUNK, HEATHER (RD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BRUNK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-2700
Mailing Address - Country:US
Mailing Address - Phone:540-241-5920
Mailing Address - Fax:
Practice Address - Street 1:37 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-2700
Practice Address - Country:US
Practice Address - Phone:540-241-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86040354133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered