Provider Demographics
NPI:1164793691
Name:DUNKER, KAREN S (RD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:S
Last Name:DUNKER
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 1:9263 E GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-4352
Mailing Address - Country:US
Mailing Address - Phone:480-529-3391
Mailing Address - Fax:
Practice Address - Street 1:9520 W PALM LN
Practice Address - Street 2:SUITE200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-4403
Practice Address - Country:US
Practice Address - Phone:623-583-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH706298133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ706298OtherDIETETIC REGISTRATION NUMBER