Provider Demographics
NPI:1194363184
Name:WUNDERLICH, DANA C (RD)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:C
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:C
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:781 VICTORIAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7137
Mailing Address - Country:US
Mailing Address - Phone:925-813-2559
Mailing Address - Fax:
Practice Address - Street 1:111 RALEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-8351
Practice Address - Country:US
Practice Address - Phone:530-332-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86076549133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered