Provider Demographics
NPI:1326091984
Name:DUNAWAY, MARVEL Y (R D, LD)
Entity Type:Individual
Prefix:MRS
First Name:MARVEL
Middle Name:Y
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:R D, 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 369
Mailing Address - Street 2:403 WEST SHERMAN
Mailing Address - City:MONROE
Mailing Address - State:IA
Mailing Address - Zip Code:50170-0369
Mailing Address - Country:US
Mailing Address - Phone:641-259-3220
Mailing Address - Fax:
Practice Address - Street 1:1515 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3354
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:641-828-5125
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00717133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered