Provider Demographics
NPI:1083346191
Name:HUNNICUTT, HEIDI RUTH
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:RUTH
Last Name:HUNNICUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N WAYNE ST APT 304
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-1885
Mailing Address - Country:US
Mailing Address - Phone:615-735-7685
Mailing Address - Fax:
Practice Address - Street 1:3903 FAIR RIDGE DR STE 209
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2944
Practice Address - Country:US
Practice Address - Phone:703-865-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered