Provider Demographics
NPI:1003916693
Name:BUNNELL, KAREN ELAINE (RD LMNT LD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:ELAINE
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:RD LMNT LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NE
Mailing Address - Zip Code:68967-0151
Mailing Address - Country:US
Mailing Address - Phone:308-824-3809
Mailing Address - Fax:308-824-3809
Practice Address - Street 1:1215 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1255
Practice Address - Country:US
Practice Address - Phone:308-995-2881
Practice Address - Fax:308-995-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30133V00000X
KS666133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275623Medicare ID - Type Unspecified